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TOPS PT, LLC
RRC330140-00 ST. JOSEPHS HOSPITAL HEALTH CENTER
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Covered Entity Details
Entity Name
ST. JOSEPHS HOSPITAL HEALTH CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330140-00
Entity Address
301 PROSPECT AVENUE
SYRACUSE, NY 13203
Medicare Provider Number
330140
Participating Start Date
10/1/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
TOPS PT, LLC
Pharmacy Address
TOPS PHARMACY #357
2265 DOWNER STREET
BALDWINSVILLE, NY 13027
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
1/24/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Meredith Anne Price, Chief Financial Officer
(315) 448-5888
Contract Pharmacy Representative
Tops Markets, LLC
Edlinda Borrero, Third Party Pharmacy Coordinator
(716) 635-5278
Signed By Date
1/18/2022
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