Covered Entity Details

DSH330125CK ROCHESTER GENERAL HOSPITAL (Active) - information as of 5/16/2025 11:33:14 PM

Main Details

Name

ROCHESTER GENERAL HOSPITAL

Subdivision Name

RGH DERMATOLOGY AT GENESEO - DERMATOLOGY

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330125CK

Medicare Provider Number

330125

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2022

Participating Start Date

10/1/2022

Participating Approval Date

8/19/2022

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Rochester Regional Health
Shawn Bishop, Vice President, RRH Revenue & Reimbursement
(585) 922-0056

Primary Contact

RRH
Robert Michael Scardino, 340B Pharmacy System Manager
(585) 319-6750

Addresses

Street Address

4302 Gateway Dr
GENESEO, NY 14454

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NY	03000557,01131126	1255360517,1356412712

Shipping Addresses

Shipping Address 1

Rochester General Hospital
1425 Portland Ave
ATTN: 340B Pharmacy
Rochester, NY 14621

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330125A	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG ALLERGY IMM AT LO - ALLERGY and IMM	10 HAGEN DR.	Rochester	NY	Active
DSH330125AA	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH FAMILY MED AT RIT - Family Medicine	181 LOMB MEMORIAL DRIVE	Rochester	NY	Active
DSH330125AB	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG CENTER FOR DERM - DERMATOLOGY & MOHS	10 HAGEN DR.	ROCHESTER	NY	Active
DSH330125AC	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH RAD ONC AT LINDEN - RAD ONCOLOGY	20 Hagen Drive	ROCHESTER	NY	Active
DSH330125AD	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH HEM ONC INF/CLIN @ LO - ONCOLOGY	20 HAGEN DRIVE	ROCHESTER	NY	Active
DSH330125AE	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG ORTHO AT BAYCREEK - Ortho	2000 EMPIRE BLVD	Webster	NY	Active
DSH330125AF	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG BAY CREEK PEDS - Primary Care	2000 EMPIRE BLVD	Webster	NY	Active
DSH330125AG	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG MIDWIFE BAYCREEK - MIDWIFERY	2000 EMPIRE BLVD	Webster	NY	Terminated
DSH330125AH	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG BAY CREEK MEDICAL - Primary Care	2000 EMPIRE BLVD	Webster	NY	Active
DSH330125AJ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH DIALYSIS-BAYCREEK - DIALYSIS	2010 EMPIRE BLVD	WEBSTER	NY	Active
DSH330125AK	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG PENN FAIR PEDS - Primary Care	2200 PENFIELD RD	Penfield	NY	Active
DSH330125AL	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH PT AT MIDTOWN - PHYSICAL THERAPY	210 East Highland Drive	ROCHESTER	NY	Terminated
DSH330125AM	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG ALRGY IMM RHEUM AP - ALLERGY, IMMUN, AND RHUEM	222 ALEXANDER ST	ROCHESTER	NY	Active
DSH330125AN	Child	DSH	ROCHESTER GENERAL HOSPITAL	BHN GMHC CHILD & YOUTH - MENTAL HEALTH	224 ALEXANDER STREET	ROCHESTER	NY	Active
DSH330125AP	Child	DSH	ROCHESTER GENERAL HOSPITAL	BHN GMHC ADULT CLINIC - MENTAL HEALTH	224 ALEXANDER STREET	ROCHESTER	NY	Active
DSH330125AQ	Child	DSH	ROCHESTER GENERAL HOSPITAL	GMH GMHC PROS - MENTAL HEALTH	224 Alexander Street	ROCHESTER	NY	Active
DSH330125AR	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG ASTHMA ALLERGY GRC - ASTHMA & ALLERGY	2300 WEST RIDGE RD.	Rochester	NY	Active
DSH330125AS	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG LP ADULT WEEKEND - ADULT CARE	2350 RIDGEWAY AVE	Rochester	NY	Terminated
DSH330125AT	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG LONG POND INT MED - Primary Care	2350 RIDGEWAY AVE	ROCHESTER	NY	Active
DSH330125AU	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG RIDGEWAY FAMILY - Primary Care	2350 RIDGEWAY AVE.	Rochester	NY	Active
DSH330125AV	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH SCHI @ CLINTON - Heart Institute	2365 SOUTH CLINTON AVENUE	Rochester	NY	Active
DSH330125AW	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH VEIN CARE LINDEN - Vein Care	30 HAGEN DRIVE	ROCHESTER	NY	Active
DSH330125AX	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH SCHI @ LINDEN OAKS - Heart Institute	30 Hagen Drive	Rochester	NY	Active
DSH330125AY	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG LINDEN MEDICAL GRP - Primary Care	30 HAGEN DRIVE	ROCHESTER	NY	Active
DSH330125AZ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH PAIN CLINIC LINDEN - PAIN	360 LINDEN OAKS DRIVE	ROCHESTER	NY	Active
DSH330125B	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH LINDEN OAKS DEXA - DEXA	10 HAGEN DRIVE	Rochester	NY	Terminated
DSH330125BA	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH HOME DIALYSIS - HOME DIALYSIS	370 EAST RIDGE RD	Rochester	NY	Active
DSH330125BB	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH HOME DIALYSIS @ HH - Dialysis	370 EAST RIDGE ROAD	Rochester	NY	Terminated
DSH330125BC	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH HEMODIALYSIS - HEMODIALYSIS	370 Ridge Rd East	Rochester	NY	Active
DSH330125BD	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG WHITE PINES MED - Primary Care	370 RIDGE RD. EAST	Rochester	NY	Terminated
DSH330125BE	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG WILLIAMSON PEDS - PRIMARY CARE	4425 OLD RIDGE RD	WILLIAMSON	NY	Active
DSH330125BF	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG WILLIAMSON FAMILY - PRIMARY CARE	4425 OLD RIDGE RD.	WILLIAMSON	NY	Active
DSH330125BG	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH HENRIETTA - Primary Care	50 MIDDLE RD	Henrietta	NY	Active
DSH330125BH	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH SPINE CENTER HEN - SPINE	50 MIDDLE RD	HENRIETTA	NY	Active
DSH330125BJ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH MAMMO HENRIETTA - MAMMOGRAPHY	50 Middle Rd	Henrietta	NY	Terminated
DSH330125BK	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH REHAB & NEURO HEN - REHAB & NEURO	50 MIDDLE RD	HENRIETTA	NY	Active
DSH330125BL	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH ORTHO HENRIETTA - ORTHO	50 MIDDLE ROAD	HENRIETTA	NY	Active
DSH330125BM	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG SODUS INT MED - PRIMARY CARE	6692 MIDDLE RD	SODUS	NY	Active
DSH330125BN	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG SODUS PEDIATRICS - PRIMARY CARE	6692 MIDDLE RD	SODUS	NY	ToBeTerminated
DSH330125BP	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG DERM SIM(Sodus) - Dermatology	6692 Middle Rd	Sodus	NY	Active
DSH330125BQ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG PENN FAIR PC - PRIMARY CARE	2200 PENFIELD ROAD	PENFIELD	NY	Active
DSH330125BR	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG DIABETES AT LYONS - DIABETES CARE	12 LEACH ROAD	LYONS	NY	Active
DSH330125BS	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH GENERAL SURGERY- VChang - OP Surgery	1299 Portland Ave	Rochester	NY	Active
DSH330125BT	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH DEPT OF SURGERY - Surgery	1415 PORTLAND AVE	Rochester	NY	Active
DSH330125BU	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH Nephrology at NWH - Nephrology	1200 DRIVING PARK AVENUE	Newark	NY	Active
DSH330125BV	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH DOS AT LINDEN OAKS - Surgery	20 HAGEN DRIVE	ROCHESTER	NY	Active
DSH330125BW	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH Heart Insititute @ Henrietta - Cardiology	50 MIDDLE ROAD	Henrietta	NY	Active
DSH330125BX	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH Dept of Medicine- Nephrology - Nephroolgy	370 Ridge Road East	Rochester	NY	Active
DSH330125BY	Child	DSH	ROCHESTER GENERAL HOSPITAL	BHN RGH ADDICTION SRVS - Addiction Services	490 E RIDGE ROAD	Rochester	NY	Active
DSH330125BZ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RRH FAM & LIFE- Primary Care - Primary Care	401 SOUTH MAIN STREET	CANANDAIGUA	NY	Active
DSH330125C	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG RHEUM INFUSION CTR - RHEUM INFUSION	10 HAGEN DRIVE	Rochester	NY	Active
DSH330125CA	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH BARIATRIC SURGERY - Bariatrics	1415 PORTLAND AVE	Rochester	NY	Active
DSH330125CB	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH BARIATRICS AT NWH - Bariatrics	1200 DRIVING PARK AVENUE	Newark	NY	Active
DSH330125CC	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH Infectious Disease Portland - Infectious Disease - Infectious Disease	1299 PORTLAND AVE, SUITE 17	Rochester	NY	Active
DSH330125CD	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG Rehab & Neurology at Baycreek - Neurology - Rehab and Neurology	2000 EMPIRE BLVD	WEBSTER	NY	Active
DSH330125CE	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH SCHI @ CANANDAIGUA - Heart Institute - Cardiology	401 SOUTH MAIN ST	CANANDAIGUA	NY	Active
DSH330125CF	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH GYN ONCOLOGY @ MOB - Oncology - Oncology	1415 PORTLAND AVE, SUITE 245	Rochester	NY	Active
DSH330125CG	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH UROLOGY @ GENESEO - UROLOGY	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CH	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH ORTHOPEDICS @ GENESEO - ORTHOPEDICS	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CJ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH ENDOCRINOLOGY @ GENESEO - ENDOCRINOLOGY	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CK	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH DERMATOLOGY AT GENESEO - DERMATOLOGY	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CL	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH FAMILY MEDICINE AT GENESEO - FAMILY MEDICINE	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CM	Child	DSH	ROCHESTER GENERAL HOSPITAL	PULMONOLOGY AT NEWARK - PULMONOLOGY	1200 DRIVING PARK AVENUE	NEWARK	NY	Active
DSH330125CN	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH CARDIOTHORACIC SURGERY AT NEWARK - CARDIOTHORACIC SURGERY	1200 DRIVING PARK AVENUE	Newark	NY	Terminated
DSH330125CP	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH GV DERM LASER SPA - Dermatology	2250 Brighton Henrietta Town Line Rd	ROCHESTER	NY	Active
DSH330125CQ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH SCHI GENESEO - Cardiology	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CR	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH GEN SURG GENESEO - GENERAL SURGERY	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CS	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH NEUROSCIENCE AT GENESEO - Neurology	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CT	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH VASCULAR GENESEO - Vascular	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CU	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH GENESEO URGENT CARE - Urgent Care	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CV	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH FINGER LAKES ENT GENESEO - Otolaryngology	4302 Gateway Dr	GENESEO	NY	Active
DSH330125CW	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH NEUROLOGY - HAGEN - Neurology	10 Hagen Drive	Rochester	NY	Active
DSH330125CX	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG CLINTON FAMILY - Family Medicine	293 UPPER FALLS BLVD	ROCHESTER	NY	Active
DSH330125CY	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWC ANTENATAL - Perinatology	1415 PORTLAND AVE	ROCHESTER	NY	Active
DSH330125CZ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG WOLCOTT INT MED - Internal Medicine	6254 LAWVILLE RD	WOLCOTT RD	NY	Active
DSH330125D	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG AIR AT LYONS - Allergy, Immunology and Rhuem	12 LEACH ROAD	Lyons	NY	Terminated
DSH330125DA	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG REFUGEE HEALTH - Family Medicine	222 ALEXANDER STREET	ROCHESTER	NY	Active
DSH330125DB	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GIM AT ALEXANDER - Internal Medicine	222 ALEXANDER STREET	Rochester	NY	Active
DSH330125DC	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GENESEE PEDIATRICS - Pediatrics	222 ALEXANDER ST	Rochester	NY	Active
DSH330125DD	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG DCRC - Endocrinology	224 ALEXANDER ST	ROCHESTER	NY	Active
DSH330125DE	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH DENTISTRY AT RHC - Dentistry	1455 EAST RIDGE ROAD	ROCHESTER	NY	Active
DSH330125DF	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG OPD AT RHC - Internal Medicine	1455 EAST RIDGE ROAD	Rochester	NY	Active
DSH330125DG	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG WOLCOTT PEDIATRICS - Pediatrics	6254 LAWVILLE RD	WOLCOTT	NY	Active
DSH330125DH	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GHS PRIMARY CARE - Internal Medicine	222 ALEXANDER STREET	ROCHESTER	NY	Active
DSH330125DJ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG NEWARK INT MED - Internal Medicine	1208 DRIVING PARK AVE	Newark	NY	Active
DSH330125DK	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWIG AT RHC - Internal Medicine	1455 EAST RIDGE ROAD	ROCHESTER	NY	Active
DSH330125DL	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWC AT CLINTON - Obstetrics and Gynecology	309 UPPER FALLS BLVD	ROCHESTER	NY	Active
DSH330125DM	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG RGPA AT RHC - Pediatrics	1455 EAST RIDGE ROAD	Rochester	NY	Active
DSH330125DN	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWC AT PORTLAND - Obstetrics and Gynecology	1415 PORTLAND AVE	ROCHESTER	NY	Active
DSH330125DQ	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWC AT ALEXANDER - Obstetrics and Gynecology	222 ALEXANDER STREET	Rochester	NY	Active
DSH330125DR	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH VASC SURG BMC - vascular surgery	8103 Oak Orchard Rd	BATAVIA	NY	Active
DSH330125DS	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH SCHI BMC - Cardiology	8103 Oak Orchard Rd	Batavia	NY	Active
DSH330125DT	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH ORTHO LINDEN OAKS - Orthopedics	360 Linden Oaks Drive	Rochester	NY	Active
DSH330125E	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG LYONS HEALTH CENTER - Primary Care	12 LEACH ROAD	Lyons	NY	Active
DSH330125F	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG NEWARK PEDIATRICS - PRIMARY CARE	1200 DRIVING PARK AVE	NEWARK	NY	Active
DSH330125G	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GANANDA FAMILY - Primary Care	1200 FAIRWAY 7	MACEDON	NY	Active
DSH330125H	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH UROLOGY @ NWH 1202 - UROLOGY	1202 DRIVING PARK AVENUE	Newark	NY	Active
DSH330125J	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG DERM NIM(Newark) - Dermatology	1208 Driving Park Ave	Newark	NY	Terminated
DSH330125K	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWC AT NEWARK - WOMENS CENTER	1250 DRIVING PARK AVE.	NEWARK	NY	Active
DSH330125L	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG TWC ANTENATAL NWH - WOMENS CENTER	1250 DRIVING PARK AVENUE	NEWARK	NY	Active
DSH330125M	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GIM AT PORTLAND - Primary Care	1299 PORTLAND AVE	Rochester	NY	Terminated
DSH330125N	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GI AT NEWARK - GI	1304 DRIVING PARK AVE.	NEWARK	NY	Terminated
DSH330125P	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG NORTHRIDGE MEDICAL - Primary Care	1338 E. RIDGE RD.	ROCHESTER	NY	Active
DSH330125Q	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH OT @ IRONDEQUOIT - OT	1381 EAST RIDGE RD	ROCHESTER	NY	Terminated
DSH330125R	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH PT @ IRONDEQUOIT - PT	1381 EAST RIDGE RD	ROCHESTER	NY	Terminated
DSH330125S	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG GERIATRIC CONSULT - geriatrics	1415 PORTLAND AVE.	Rochester	NY	Active
DSH330125T	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH PAIN CENTER - PAIN CENTER	1415 PORTLAND AVE.	ROCHESTER	NY	Terminated
DSH330125U	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH NEUROLOGY @ MOB - NEUROLOGY	1415 Portland Avenue	Rochester	NY	Terminated
DSH330125V	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH SCHI MOB - Heart Institute	1415 Portland Avenue	Rochester	NY	Active
DSH330125W	Child	DSH	ROCHESTER GENERAL HOSPITAL	RMG VASC SURG ASSOC - Vascular Surg	1445 Portland Ave	Rochester	NY	Active
DSH330125X	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH OPHTHALM AT RHC - OPTHOMETRY	1455 EAST RIDGE ROAD	ROCHESTER	NY	Active
DSH330125Y	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH ORAL SURG AT RHC - ORAL SURGERY	1455 EAST RIDGE ROAD	ROCHESTER	NY	Active
DSH330125Z	Child	DSH	ROCHESTER GENERAL HOSPITAL	RGH ST ANN'S WOUNDCARE - WOUNDCARE	1500 PORTLAND AVENUE	Rochester	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 10:50:37 AM	9/3/2024 4:29:29 PM	9/3/2024 4:29 PM
Details	Last Recertification Date	Update	Recertification		8/22/2023 10:50:37 AM	8/22/2023 10:50 AM
Contacts	Primary Contact	Update	PC Change Request	Kinter, Karen M Vice President of Specialty Revenue Programs Rochester Regional 5853683537	Scardino, Robert Michael 340B Pharmacy System Manager RRH 5853196750	7/20/2023 3:45 PM
Contacts	Authorizing Official	Update	Change Request	Thomas, Hugh Executive Vice President, Chief Administrative Officer Rochester Regional Health 5859224941	Bishop, Shawn Vice President, RRH Revenue & Reimbursement Rochester Regional Health 5859220056	6/12/2023 3:55 PM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Thomas, Hugh Executive Vice President, Chief Administrative Officer Rochester Regional Health 5859224941	8/19/2022 2:05 PM
Details	340B ID	Update	New Registration		DSH330125CK	8/19/2022 2:05 PM
Details	Entity Subname	Update	New Registration	RGH DERMATOLOGY AT GENESEO	RGH DERMATOLOGY AT GENESEO - DERMATOLOGY	8/19/2022 2:05 PM
Dates	Participating Approval Date	Update	New Registration		8/19/2022 2:05:13 PM	8/19/2022 2:05 PM
Details	State	Update	New Registration	Pending	Approved	8/19/2022 2:05 PM
Dates	Signed By Date	Update	New Registration		8/9/2022 12:52:12 PM	8/19/2022 2:05 PM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	8/19/2022 2:05 PM
Contacts	Primary Contact	Update	Profile Change Request	Kinter, Karen M 340B Program Director Rochester General Hospital 5853683537	Kinter, Karen M Vice President of Specialty Revenue Programs Rochester Regional 5853683537	7/29/2022 8:15 AM
Addresses	Main Address	Insert	New Registration		4302 Gateway Dr GENESEO, NY 14454	7/13/2022 7:33 AM
Addresses	Shipping Address	Insert	New Registration		Rochester General Hospital 1425 Portland Ave ATTN: 340B Pharmacy Rochester, NY 14621	7/13/2022 7:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2022 7:33 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		03000557	7/13/2022 7:33 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	7/13/2022 7:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2022 7:33 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01131126	7/13/2022 7:33 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	7/13/2022 7:33 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1255360517	7/13/2022 7:33 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	7/13/2022 7:33 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1356412712	7/13/2022 7:33 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	7/13/2022 7:33 AM
Contacts	Authorizing Official	Insert	New Registration		Thomas, Hugh Executive Vice President, Chief Administrative Officer Rochester Regional Health 5859224941	7/13/2022 7:33 AM
Contacts	Primary Contact	Insert	New Registration		Kinter, Karen M 340B Program Director Rochester General Hospital 5853683537	7/13/2022 7:33 AM
Details	Assistance Received From Date	Insert	New Registration			7/13/2022 7:33 AM
Details	Assistance Received To Date	Insert	New Registration			7/13/2022 7:33 AM
Details	Last Recertification Date	Insert	New Registration			7/13/2022 7:33 AM
Details	Grant Number	Insert	New Registration			7/13/2022 7:33 AM
Details	340B ID	Insert	New Registration			7/13/2022 7:33 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2022 7:33 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2022 7:33 AM
Details	Medicare Provider Number	Insert	New Registration		330125	7/13/2022 7:33 AM
Details	Entity Name	Insert	New Registration		ROCHESTER GENERAL HOSPITAL	7/13/2022 7:33 AM
Details	NOFO Number	Insert	New Registration			7/13/2022 7:33 AM
Details	Program Code	Insert	New Registration		DSH	7/13/2022 7:33 AM
Details	Entity Subname	Insert	New Registration		RGH DERMATOLOGY AT GENESEO	7/13/2022 7:33 AM
Dates	Participating Approval Date	Insert	New Registration			7/13/2022 7:33 AM
Details	State	Insert	New Registration		Pending	7/13/2022 7:33 AM
Dates	Registration Date	Insert	New Registration		7/13/2022 7:33:37 AM	7/13/2022 7:33 AM
Dates	Signed By Date	Insert	New Registration			7/13/2022 7:33 AM
Dates	Start Date	Insert	New Registration			7/13/2022 7:33 AM
Terminations	Termination Comments	Insert	New Registration			7/13/2022 7:33 AM
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