Contract Pharmacy Details

CVS ALBANY, L.L.C.
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

CVS ALBANY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00466
685 PARK AVENUE
ROCHESTER, NY 14607

Pharmacy Comments

Contract Details

Approval Date

10/10/2013

Contract Begin Date

1/1/2014

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

Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

10/10/2013

340B Drug Pricing Program Database