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MEDICAL ADMIN ASSOC INC
RRC330164-06 HIGHLAND HOSPITAL OF ROCHESTER
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Covered Entity Details
Entity Name
HIGHLAND HOSPITAL OF ROCHESTER
Subdivision Name
GENESEE VALLEY FAMILY MEDICINE
Type
Rural Referral Center
340B ID
RRC330164-06
Entity Address
118 MAIN ST
MOUNT MORRIS, NY 14510-1218
Medicare Provider Number
330164
Outpatient Facility Provider Number
Participating Start Date
4/1/2017
Last Recertification Date
8/18/2024
Entity Termination Date
1/1/2025
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
1/1/2025
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
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