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TRILLIUM HEALTH, INC.
DSH330285AW STRONG MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STRONG MEMORIAL HOSPITAL
Subdivision Name
Outpatient Oncology Clinic - Brockport
Type
Disproportionate Share Hospital
340B ID
DSH330285AW
Entity Address
156 WEST AVENUE
URMC STRONG WEST
Brockport, NY 14420-1229
Medicare Provider Number
330285
Outpatient Facility Provider Number
330285
Participating Start Date
10/1/2014
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
TRILLIUM HEALTH, INC.
Pharmacy Address
TRILLIUM HEALTH PHARMACY
259 MONROE AVE
LOWER LEVEL
ROCHESTER, NY 14607-3632
Pharmacy Comments
Contract Details
Approval Date
1/14/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
4/1/2018
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Fuller Spencer, Chief Financial Officer
(585) 275-3033
Contract Pharmacy Representative
Trillium Health
MARK Joseph MALAHOSKY, VP PHARMACY SERVICES
(585) 210-4152
Signed By Date
1/14/2018
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