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AHG OF NEW YORK, INC
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
AHG OF NEW YORK, INC
Pharmacy Address
DBA: ACCREDO
125 CLEARBROOK RD STE 122
ELMSFORD, NY 10523-1119
Pharmacy Comments
Contract Details
Approval Date
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shawn Bishop, Vice President, RRH Revenue & Reimbursement
(585) 922-0056
Contract Pharmacy Representative
Accredo Health Group, Inc.
Travis Behrens, Lead Director, 340B Client Sales
(407) 988-7044
Signed By Date
1/4/2024
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