Contract Pharmacy Details

MEDICAL ADMINISTRATIVE ASSOCIATES INC
CH022070 ANTHONY L JORDAN HEALTH CORP

Covered Entity Details

Entity Name

ANTHONY L JORDAN HEALTH CORP

Subdivision Name

Main Site

Type

HRSA-Funded Health Center

340B ID

CH022070

Entity Address

82 Holland St
Rochester, NY 14605-2131

Grant Number

H80CS21582

Participating Start Date

10/1/2011

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

MEDICAL ADMINISTRATIVE ASSOCIATES INC

Pharmacy Address

DBA: HIGHLAND PHARMACY AT BROOKS LANDING
910 GENESEE ST STE A
ROCHESTER, NY 14611

Pharmacy Comments

Contract Details

Approval Date

2/24/2005

Contract Begin Date

2/24/2005

Carve-In Effective Date

Contract Comments

01/20/2012 contract transferred back upon termination of CH02112G; 4/5/2006 - TRANSFERRED TO NEW 340B ID # (SAME ORGANIZATION BUT NEW GRANT);02/24/2005 original contract begin date

Contacts

Covered Entity Signing Official

Bridgette Wiefling, CEO
(585) 423-2878

Contract Pharmacy Representative

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

Signed By Date

1/20/2012

340B Drug Pricing Program Database