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ROCHESTER GENERAL HOSPITAL
DSH330265 Clifton Springs Hospital
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Covered Entity Details
Entity Name
Clifton Springs Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330265
Entity Address
2 Coulter Road
Clifton Springs, NY 14432
Medicare Provider Number
330265
Participating Start Date
7/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ROCHESTER GENERAL HOSPITAL
Pharmacy Address
DBA: WILSON PHARMACY
1425 PORTLAND AVE BLDG 1
ROCHESTER, NY 14621-3001
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
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
Rochester Regional Health
Tiffany Pepe, Pharmacy Manager
(585) 338-4972
Signed By Date
10/15/2019
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