Contract Pharmacy Details

TOPS MARKETS
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

Pharmacy Address

TOPS PHARMACY #429
999 EAST RIDGE ROAD
ROCHESTER, NY 14621

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

340B Drug Pricing Program Database