Contract Pharmacy Details

STRONG MEMORIAL HOSPITAL
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

STRONG MEMORIAL HOSPITAL

Pharmacy Address

601 ELMWOOD AVENUE BOX 638
OUTPATIENT PHARMACY
ROCHESTER, NY 14642

Pharmacy Comments

Contract Details

Approval Date

4/8/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017

Contacts

Covered Entity Signing Official

Kevin Segerson, Director of Finance
(585) 341-6686

Contract Pharmacy Representative

URMC
Jason Smith, Associate Director Ambulatory Pharmacy
(585) 785-5193

Signed By Date

4/8/2016

340B Drug Pricing Program Database