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WEGMANS FOOD MARKETS, INC.
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
WEGMANS FOOD MARKETS, INC.
Pharmacy Address
ATTN: PHARMACY
851 FAIRPORT RD
EAST ROCHESTER, NY 14445
Pharmacy Comments
02/06/2012 changed store #(was 104)
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
Pharmacy Business Relations Mgr
Brian Pompo, Pharmacy Business Relations Manager
(315) 546-1100 Ext: 431
Signed By Date
7/2/2013
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