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WALMART PHARMACY 10-5282
DSH330226 UNITY HOSPITAL OF ROCHESTER
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Covered Entity Details
Entity Name
UNITY HOSPITAL OF ROCHESTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330226
Entity Address
1555 LONG POND ROAD
ROCHESTER, NY 14626
Medicare Provider Number
330226
Participating Start Date
3/15/2022
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5282
Pharmacy Address
3800 DEWEY AVE
GREECE, NY 14616
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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