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TOPS MARKETS
DSH330164 HIGHLAND HOSPITAL OF ROCHESTER
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Covered Entity Details
Entity Name
HIGHLAND HOSPITAL OF ROCHESTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330164
Entity Address
1000 SOUTH AVENUE
ROCHESTER, NY 14620
Medicare Provider Number
330164
Participating Start Date
5/13/2013
Last Recertification Date
8/17/2016
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
TOPS MARKETS
Pharmacy Address
TOPS PHARMACY #403
2345 BUFFALO RD
GATES, NY 14624
Pharmacy Comments
Contract Details
Approval Date
7/2/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
LEONARD J. SHUTE, SENIOR DIRECTOR OF FINANCE, CFO
(585) 275-3033
Contract Pharmacy Representative
Tops Markets
Brian Huckle, Director of Pharmacy
(716) 635-5275
Signed By Date
7/2/2013
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