Contract Pharmacy Details

TOPS MARKETS, LLC
DSH330164 HIGHLAND HOSPITAL OF ROCHESTER

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, LLC

Pharmacy Address

1215 JEFFERSON RD
ROCHESTER, NY 14623

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

1/15/2016
Pharmacy closed

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

340B Drug Pricing Program Database