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TOPS MARKETS, LLC
DSH330073 UNITED MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UNITED MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330073
Entity Address
127 NORTH STREET
BATAVIA, NY 14020
Medicare Provider Number
330073
Participating Start Date
1/1/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
TOPS MARKETS, LLC
Pharmacy Address
390 WEST MAIN ST
BATAVIA, NY 14020
Pharmacy Comments
Contract Details
Approval Date
7/16/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert L. Chiavetta, CFO
(585) 344-5249
Contract Pharmacy Representative
Tops Markets
Brian Huckle, Director of Pharmacy
(716) 635-5275
Signed By Date
7/16/2013
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