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TOPS MARKETS
DSH330005 KALEIDA HEALTH
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Covered Entity Details
Entity Name
KALEIDA HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330005
Entity Address
100 High Street
BUFFALO, NY 14203
Medicare Provider Number
330005
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
TOPS MARKETS
Pharmacy Address
DBA TOPS PHARMACY #49
355 ORCHARD PARK ROAD
WEST SENECA, NY 14224
Pharmacy Comments
Contract Details
Approval Date
1/25/2013
Contract Begin Date
1/25/2013
Carve-In Effective Date
Contract Comments
01/25/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
12/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Kessler, CFO
(716) 859-8836
Contract Pharmacy Representative
Tops Markets
Brian Huckle, Director of Pharmacy
(716) 635-5275
Signed By Date
1/9/2013
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