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WALMART PHARMACY 10-5169
DSH330125 ROCHESTER GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ROCHESTER GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330125
Entity Address
1425 PORTLAND AVENUE
ROCHESTER, NY 14621
Medicare Provider Number
330125
Participating Start Date
10/1/2019
Last Recertification Date
8/15/2024
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
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shawn Bishop, Vice President, RRH Revenue & Reimbursement
(585) 922-0056
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/4/2023
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