Contract Pharmacy Details

MEDICAL ADMIN ASSOC INC
RRC330164-09 HIGHLAND HOSPITAL OF ROCHESTER

Covered Entity Details

Entity Name

HIGHLAND HOSPITAL OF ROCHESTER

Subdivision Name

HIGHLAND BREAST CARE CENTER

Type

Rural Referral Center

340B ID

RRC330164-09

Entity Address

500 RED CREEK DR
Suite 130
ROCHESTER, NY 14623-4284

Medicare Provider Number

330164

Outpatient Facility Provider Number

Participating Start Date

1/1/2019

Last Recertification Date

8/18/2024

Pharmacy Details

Pharmacy Name

MEDICAL ADMIN ASSOC INC

Pharmacy Address

DBA: HIGHLAND APOTHECARY
777 CLINTON AVE S
ROCHESTER, NY 14620

Pharmacy Comments

Contract Details

Approval Date

10/13/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

1/1/2018

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Covered Entity Terminated

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

10/13/2017

340B Drug Pricing Program Database