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TOPS MARKETS, LLC
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, LLC
Pharmacy Address
128 WEST MAIN STREET
LEROY, NY 14482
Pharmacy Comments
Contract Details
Approval Date
10/3/2016
Contract Begin Date
1/1/2017
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
John Kirk, Third Party Coordinator
(716) 635-5277
Signed By Date
10/3/2016
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