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WALMART PHARMACY 10-5169
RRC330164-00 HIGHLAND HOSPITAL OF ROCHESTER
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Covered Entity Details
Entity Name
HIGHLAND HOSPITAL OF ROCHESTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330164-00
Entity Address
1000 South Avenue
ROCHESTER, NY 14620
Medicare Provider Number
330164
Participating Start Date
4/1/2017
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Fuller Spencer, Chief Financial Officer
(585) 275-3033
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/18/2023
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