340B Drug Pricing Program Database


DSH330241 UNIVERSITY HOSPITAL (Active) - information as of 6/1/2025 4:49:47 AM

Main Details
UNIVERSITY HOSPITAL
Disproportionate Share Hospital
No
DSH330241
330241


Additional Details
Active
7/1/2005
7/1/2005
6/21/2005
8/12/2024

Contacts

SUNY Upstate Medical University Hospital
Stuart M. Wright, Chief Financial Officer
(315) 464-5179

SUNY Upstate Medical University Hospital
Amanda Marzella, 340B Contract Pharmacy Manager
(315) 464-6039

Addresses

750 East Adams Street
Syracuse, NY 13210

Upstate University Hospital
750 East Adams Street
Syracuse, NY 13210


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
NEW ADD 7/0506/21/2005
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NY03001723,06561191,07399897,050622531578554630,1740796697,1396330932,1306567474
Shipping Addresses

Upstate University Hospital
117 Monroe Street
SYRACUSE, NY 13210

Upstate University Hospital at Community
4900 Broad Road
Syracuse, NY 13215

State University of New York Outpatient Pharmacy
750 East Adams Street, Lobby
Syracuse, NY 13210

State University of New York Out-Patient Pharmacy at UCH
5000 West Seneca Turnpike
STE. A
Syracuse, NY 13215

Upstate University Hospital
750 East Adams Street
Syracuse, NY 13210

State University of New York- Upstate Outpatient Pharmacy at Nappi
725 East Adams Street
RM 1031
Syracuse, NY 13210
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract Detail31ST & 3RD PHARMACY INCD/B/A AVITA PHARMACY 1063 1860 WALT WHITMAN RD STE 700
MELVILLENY1174710/21/202001/01/2021  01/01/2021
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750211/21/201701/01/2018  11/21/2017
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884911/21/201701/01/2018  11/21/2017
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/202104/06/2021  04/06/2021
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282211/21/201701/01/2018  11/21/2017
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624111/21/201701/01/2018 09/18/202304/26/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349211/21/201701/01/2018  11/21/2017
Contract DetailACCREDO HEALTH GROUP, INC.45 ROUTE 46 EAST SUITE 609
PINE BROOKNJ0705807/11/201910/01/2019  10/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/18/202210/01/2022  10/01/2022
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/03/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/03/202404/01/2024  04/01/2024
Contract DetailBRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET 		AVONMA0232201/17/201904/01/2019 10/01/201912/17/2019
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005611/21/201701/01/2018 04/01/202404/16/2024
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621911/21/201701/01/2018 04/01/202404/16/2024
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175711/21/201701/01/2018 04/01/202404/16/2024
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700411/21/201701/01/2018 04/01/202404/16/2024
Contract DetailCMV PHARMACY INC.DBA DOUGHERTY PHARMACY 1017 MADISON MARKETPLACE
HAMILTONNY1334610/09/202301/01/2024  01/01/2024
Contract DetailCMV PHARMACY INC.DBA DOUGHERTY PHARMACY 14 E MAIN ST.
PO BOX 237 		MORRISVILLENY1340810/09/202301/01/2024  01/01/2024
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/09/201801/01/2019  01/01/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268310/04/202001/01/2021 04/08/202204/13/2022
Contract DetailECKERD CORPORATIONRITE AID #10730 113 DOWNER STREET
BALDWINSVILLENY1302710/15/201301/01/2014 07/01/201904/28/2020
Contract DetailECKERD CORPORATIONRITE AID #10731 8417 OSWEGO ROAD
BALDWINSVILLENY1302710/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10733 5335 WEST GENESEE ST STE 20
CAMILLUSNY1303110/15/201301/01/2014 07/01/201904/28/2020
Contract DetailECKERD CORPORATIONRITE AID #10734 423 SOUTH PETERBORO STREET
CANASTOTANY1303210/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10736 7939 BREWERTON ROAD
CICERONY1303910/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10741 6430 KIRKVILLE ROAD
EAST SYRACUSENY1305710/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10742 101 TOWNE DR.
FAYETTEVILLENY1306610/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10749 7398 OSWEGO ROAD
LIVERPOOLNY1309010/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10751 8230 CAZENOVIA ROAD
MANLIUSNY1310410/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10755 5942 SOUTH SALINA STREET
SYRACUSENY1320510/15/201301/01/2014 02/20/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10756 1820 TEALL AVE
SYRACUSENY1320610/15/201301/01/2014 07/01/201904/28/2020
Contract DetailECKERD CORPORATIONRITE AID #10757 3120 JAMES STREET
SYRACUSENY1320610/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10758 401 WEST SENECA TURNPIKE
SYRACUSENY1320710/15/201301/01/2014 02/20/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10762 2616 BREWERTON ROAD
MATTYDALENY1321110/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10763 5380 WEST TAFT ROAD
NORTH SYRACUSENY1321210/15/201301/01/2014 07/01/201904/28/2020
Contract DetailECKERD CORPORATIONRITE AID #10764 3649 ERIE BLVD E STE 215B
SYRACUSENY1321410/15/201301/01/2014 02/13/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10766 4751 ONONDAGA BLVD.
SYRACUSENY1321910/15/201301/01/2014 02/20/201804/13/2018
Contract DetailECKERD CORPORATIONRITE AID #10768 602 NOTTINGHAM ROAD
SYRACUSENY1322410/15/201301/01/2014 02/20/201804/13/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/13/201807/01/2018  04/13/2018
Contract DetailFRANK & FRAN DRUGS INC360 W 1ST ST S
FULTONNY13069-244110/04/202001/01/2021  01/01/2021
Contract DetailGENOA HEALTHCARE LLC1045 JAMES ST STE P100
SYRACUSENY1320304/11/202307/01/2023  07/01/2023
Contract DetailGENOA HEALTHCARE LLC329 N SALINA ST SUITE P
SYRACUSENY1320304/11/202307/01/2023  07/01/2023
Contract DetailGIFFORD & WEST PHARMACY300 GIFFORD STREET
SYRACUSENY1320410/12/201601/01/2017 10/01/201704/13/2018
Contract DetailINNOVATIVE SERVICES INCD/B/A UPSTATE HOMECARE 200 AIRPARK DR STE 100
ROCHESTERNY14624-571604/01/202407/01/2024  07/01/2024
Contract DetailINNOVATIVE SERVICES INC.D/B/A UPSTATE HOMECARE 6700 THOMPSON RD
SYRACUSENY1321107/17/202310/01/2023 01/01/202501/13/2025
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #24 3873 ROME ROAD
PULASKINY1314210/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #32 9543 ROUTE 11
BREWERTONNY1302910/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #43 21 E. GENESEE STREET
BALDWINSVILLENY1302710/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #64 7065 MANLIUS CENTER ROAD
EAST SYRACUSENY1305710/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #74 596 ROUTE 11
TULLYNY1315910/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #79 437 ELECTONICS PARKWAY
LIVERPOOLNY1308810/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #85 104 LAFAYETTE ROAD
SYRACUSENY1320510/03/201301/01/2014  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #115 750 E. ADAMS ST.
SYRACUSENY1321010/03/201301/01/2014 05/25/201803/19/2019
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #03 2 PRESTON ST
CAMDENNY1331610/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #37 7998 ROUTE 31
BRIDGEPORTNY13030-947310/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #31 5221 WEST TAFT ROAD
NORTH SYRACUSENY1321210/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #44 1057 RT. 5 EAST
ELBRIDGENY1306010/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #46 540 GENESEE STREET
CHITTENANGONY1303710/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #47 3318 MAIN STREET
MEXICONY1311410/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #51 7608 OSWEGO ROAD
STE 21 		LIVERPOOLNY1309010/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #54 4202 WEST GENESEE STREET
C/O PHARMACY 		SYRACUSENY1321910/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #61 8150 THOMPSON ROAD
CICERONY1303910/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #68 103 UTICA ST
HAMILTONNY1334610/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #67 41 ALBANY ST
CAZENOVIANY1303510/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #72 23 FENNEL STREET
SKANEATELESNY1315210/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #87 406 BUTTERNUT STREET
SYRACUSENY1320810/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #90 115 ONEIDA STREET
FULTONNY1306910/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #108 2912 JAMES STREET
SYRACUSENY1320610/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #113 307 NOTTINGHAM ROAD
SYRACUSENY1321010/12/201601/01/2017  07/13/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #73 130 MAIN STREET
MORAVIANY1311810/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #15 1304 WASHINGTON ST
WATERTOWNNY1360110/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #04 10923 US ROUTE 11
ADAMSNY1360510/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #07 3666 NYS ROUTE 281
CORTLANDNY1304510/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #62 62 OWASCO STREET
AUBURNNY1302110/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #36 14 CLINTON AVENUE
CORTLANDNY13045-219710/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #63 187 STATE STREET
AUBURNNY1302110/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #30 905 COFFEEN STREET
WATERTOWNNY1360110/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #13 1729 STATE STREET
WATERTOWNNY1360110/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #20 7395 UTICA BLVD
LOWVILLENY1336710/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #53 174 WEST BRIDGE STREET
C/O PHARMACY 		OSWEGONY1312610/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #75 2783 NYS RT 31
WEEDSPORTNY1316610/18/201901/01/2020  01/01/2020
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #84 12 FRANKLIN AVENUE
CLINTONNY1332301/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #09 700 CANTON STREET
OGDENSBURGNY1366901/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #34 371 EAST MAIN ST
GOUVERNEURNY1364201/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #06 401 STATE STREET
CARTHAGENY1361901/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #01 17 CLINTON STREET
GOUVERNEURNY1364201/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #08 22056 U.S. ROUTE 11
WATERTOWNNY1360101/03/202204/01/2022 01/25/202402/16/2024
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #42 21 NYS ROUTE 12
ALEXANDRIA BAYNY1360701/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #82 44 NORTH STREET
DRYDENNY1305301/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #48 822 JAMES STREET
CLAYTONNY1362401/03/202204/01/2022  04/01/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.DBA: KINNEY DRUGS CF 471 E MAIN ST
UNIT 5 		GOUVERNEURNY1364204/11/202407/01/2024  07/01/2024
Contract DetailNOBLE HEALTH SERVICES INC.6040 TARBELL ROAD
SYRACUSENY1320607/12/201410/01/2014  07/13/2017
Contract DetailONCOMED THE ONCOLOGY PHARMACY OF BUFFALOD/B/A ONCO360 140 JOHN JAMES AUDUBON PKWY STE 101
AMHERSTNY1422810/12/201601/01/2017  07/13/2017
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191301/17/201904/01/2019 09/01/202007/06/2021
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/03/202301/01/2024  01/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260110/03/202301/01/2024  01/01/2024
Contract DetailOPTUM INFUSION SERVICES 101, INC.931 CONKLIN ST STE D
FARMINGDALENY11735-242904/11/202407/01/2024  07/01/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/11/202407/01/2024  07/01/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946204/11/202407/01/2024  07/01/2024
Contract DetailOPTUM INFUSION SERVICES 550, LLC7167 E. KEMPER RD.
CINCINNATIOH4524904/11/202407/01/2024  07/01/2024
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/08/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/08/202204/08/2022  04/11/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/03/202301/01/2024  01/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/17/201904/01/2019  04/01/2019
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110101/17/201904/01/2019  04/01/2019
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/04/202001/01/2021  01/01/2021
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660810/04/202001/01/2021 05/27/202205/27/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/04/202001/01/2021  01/01/2021
Contract DetailOSWEGO VALLEY PHARMACY INCTHE MEDICINE PLACE 464 MAIN ST
PHOENIXNY1313510/04/202001/01/2021  01/01/2021
Contract DetailPARKWAY DRUGS OF ONEIDACOUNTY SOUTH INC 485 FRENCH RD
UTICANY1350210/24/201801/01/2019  01/01/2019
Contract DetailPARKWAY DRUGS OF ONEIDA CO1256 ALBANY ST
UTICANY1350110/24/201801/01/2019  01/01/2019
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/09/201801/01/2019 10/01/202210/26/2022
Contract DetailPROACT PHARMACY SERVICES, INC.1226 US HIGHWAY 11
GOUVERNEURNY1364210/03/201301/01/2014  07/13/2017
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514611/21/201701/01/2018 04/01/202404/16/2024
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/03/202404/01/2024  04/01/2024
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #633 1819 WEST GENESEE ST., STE 3
SYRACUSENY1320410/15/201301/01/2014 02/20/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #636 519 BUTTERNUT STREET
SYRACUSENY1320810/15/201301/01/2014 07/01/201904/28/2020
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #755 104 GENESEE STREET
ONEIDANY1342110/15/201301/01/2014 02/13/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #3424 300 WEST MANLIUS STREET
EAST SYRACUSENY1305710/15/201301/01/2014 02/13/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #3623 522 W. ONONDAGA ST.
SYRACUSENY1320410/15/201301/01/2014 02/20/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #4297 1900 GRANT BOULEVARD
SYRACUSENY1320810/15/201301/01/2014 02/13/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #4457 110 EAST BROADWAY
FULTONNY1306910/15/201301/01/2014 02/13/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #546 301 SOUTH SALINA STREET
SYRACUSENY1320210/15/201301/01/2014 02/20/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #631 4001 SOUTH SALINA STREET
SYRACUSENY1320510/15/201301/01/2014 02/20/201804/13/2018
Contract DetailRITE AID OF NEW YORK, INC.RITE AID #632 1405 EAST GENESEE STREET
SYRACUSENY1321010/15/201301/01/2014 02/20/201804/13/2018
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104210/12/201601/01/2017  07/13/2017
Contract DetailTOPS MARKETSTOPS PHARMACY #504 352 GENESEE STREET
AUBURNNY1302101/15/202404/01/2024  04/01/2024
Contract DetailTOPS MARKETS700 FIRST NORTH STREET
SYRACUSENY1320801/15/202404/01/2024  04/01/2024
Contract DetailTOPS PT, LLCTOPS PHARMACY #357 2265 DOWNER STREET
BALDWINSVILLENY1302701/15/202404/01/2024  04/01/2024
Contract DetailVINCE'S PHARMACY OF CAMILLUSDBA MEDICINE SHOPPE 240 TOWNSHIP BLVD STE 30
CAMILLUSNY13031-179310/01/202101/01/2022 01/01/202501/13/2025
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #19542 7398 OSWEGO RD
LIVERPOOLNY1309010/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #19049 2616 BREWERTON RD
MATTYDALENY1321110/09/201810/09/2018 04/03/202404/11/2024
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #19977 104 GENESEE ST
ONEIDANY1342110/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #17643 8230 CAZENOVIA RD
MANLIUSNY1310410/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #17566 250 STATE ROUTE 104
OSWEGONY1312601/21/202103/16/2021  03/16/2021
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #19496 4764 SALINA ST
PULASKINY1314201/21/202103/16/2021 11/16/202201/19/2023
Contract DetailWALGREEN EASTERN CO., INCWALGREENS 114 N MAIN ST
NORTH SYRACUSENY1321201/21/202103/16/2021 11/10/202201/19/2023
Contract DetailWALGREEN EASTERN CO., INCWALGREENS #19952 82 NORTH BROAD ST
NORWICHNY1381507/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19349 602 NOTTINGHAM RD
SYRACUSENY1322410/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.RITE AID #10731 8417 OSWEGO RD
BALDWINSVILLENY1302710/09/201801/01/2019 10/10/201810/24/2018
Contract DetailWALGREEN EASTERN CO., INC.RITE AID #03424 300 W MANLIUS ST
EAST SYRACUSENY1305710/09/201810/09/2018 01/12/202102/04/2021
Contract DetailWALGREEN EASTERN CO., INC.RITE AID #04297 1900 GRANT BLVD
SYRACUSENY13208-302210/09/201810/09/2018 06/12/201910/21/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 10158 3948 ROUTE 281
CORTLANDNY13045-885110/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.RITE AID #00546 301 S SALINA ST
SYRACUSENY1320210/09/201810/09/2018 11/15/201803/19/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS # 18166 101 TOWNE DR
FAYETTEVILLENY1306610/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.RITE AID #10764 3649 ERIE BLVD E
STE 215B 		SYRACUSENY1321410/09/201810/09/2018 06/10/201910/21/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 1819 W GENESEE ST
SYRACUSENY1320410/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #19377 4001 S SALINA ST
SYRACUSENY1320510/09/201810/09/2018 01/27/202503/13/2025
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18064 7939 BREWERTON RD
CICERONY1303910/09/201810/09/2018 04/24/202505/01/2025
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS # 19402 6430 KIRKVILLE RD
STE 5 		EAST SYRACUSENY1305710/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 10157 150 GRANT AVENUE
AUBURNNY13021-150210/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09413 5206 W GENESSE ST
CAMILLUSNY13031-220210/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #19549 4751 ONONDAGA BLVD
SYRACUSENY1321910/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 5173 W. TAFT RD.
NORTH SYRACUSENY1321210/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 2329 JAMES ST.
SYRACUSENY1320610/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 401 W SENECA TPKE
SYRACUSENY1320710/09/201810/09/2018 11/10/202101/11/2022
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #10750 6189 ROUTE 31
CICERONY1303910/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 1405 E GENESEE ST
SYRACUSENY1321010/09/201810/09/2018 05/02/202305/04/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17389 201 W BROADWAY
FULTONNY1306910/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 17213 423 S PETERBORO ST
CANASTOTANY1303210/09/201810/09/2018 11/09/202201/19/2023
Contract DetailWALGREEN EASTERN CO., INC.RITE AID #10731 8417 OSWEGO RD
BALDWINSVILLENY1302710/09/201810/09/2018 10/09/201807/06/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #10749 2231 DOWNER ST.
BALDWINSVILLENY13027-670110/09/201801/01/2019  01/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 522 W ONONDAGA ST
SYRACUSENY1320410/09/201810/09/2018 02/21/202203/03/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19145 5942 SOUTH SALINA STREET
SYRACUSENY13205-332610/09/201810/09/2018  10/11/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS SPECIALTY PHARMACY #16537 619 CHESTNUT ST.
SPRINGFIELDMA0110704/30/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17097 1616 BLACK RIVER BLVD N
ROMENY13440-360901/14/202103/16/2021  03/16/2021
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS # 17301 95 NELSON ST
CAZENOVIANY1303501/14/202103/16/2021  03/16/2021
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17204 170 PORT WATSON ST
CORTLANDNY1304501/14/202103/16/2021  03/16/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #10159 201 S. JAMES ST.
ROMENY1344001/14/202103/16/2021  03/16/2021
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19814 3035 EAST AVE
CENTRAL SQUARENY13036-261101/14/202103/16/2021 03/27/202304/11/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 17848 1365 W GENESEE ST
CHITTENANGONY1303701/21/202103/16/2021 04/30/202505/01/2025
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 19612 314 GENESEE ST
AUBURNNY13021-310201/11/202204/01/2022 11/15/202201/19/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17276 3588 STATE ROUTE 31
BALDWINSVILLENY13027-823201/11/202204/01/2022 11/07/202411/13/2024
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19736 5651 WHISKEY HILL RD
WOLCOTTNY1459007/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09799 49 KELLOGG RD
NEW HARTFORDNY13413-284907/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 19353 8052 STATE ROUTE 12
BARNEVELDNY1330407/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09798 4855 COMMERCIAL DR
NEW HARTFORDNY13413-621207/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 208 HERKIMER RD
UTICANY13502-230807/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS # 17776 102 EAST SCHUYLER ST
BOONVILLENY1330907/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 10219 929 ARSENAL ST
WATERTOWNNY13601-230507/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS 100 E MAIN ST
ENDICOTTNY1376007/18/202210/01/2022  10/01/2022
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18984 85 ROBINSON STREET
BINGHAMTONNY13901-252110/17/202201/01/2023  01/01/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09800 1750 GENESEE STREET
UTICANY13502-542910/17/202201/01/2023  01/01/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 10291 335 MAIN ST
JOHNSON CITYNY1379010/17/202201/01/2023  01/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/09/201801/01/2019  01/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/14/202103/16/2021  03/16/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/21/202103/16/2021  03/16/2021
Contract DetailWAYNE DRUG CO INCWAYNE DRUG CO 24 W BRIDGE ST
OSWEGONY1312610/08/202401/01/2025  01/01/2025
Contract DetailWAYNE DRUG OF PULASKI INCDBA WAYNE DRUG OSWEGO CO 24 W BRIDGE ST
OSWEGONY13126-205107/10/202310/01/2023 01/01/202501/13/2025
Contract DetailWEGMANS FOOD MARKETS, INC7519 OSWEGO ROAD ATTN: PHARMACY
LIVERPOOLNY13090-292701/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.6789 E. GENESEE STREET ATTN: PHARMACY
FAYETTEVILLENY1306601/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.4722 ONONDAGA BLVD ATTN: PHARMACY
SYRACUSENY1321901/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.7954 BREWERTON ROAD ATTN: PHARMACY
CICERONY1303901/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.4979 WEST TAFT ROAD ATTN: PHARMACY
LIVERPOOLNY1308801/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.3953 ROUTE 31 ATTN: PHARMACY
LIVERPOOLNY1309001/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.4256 JAMES STREET ATTN: PHARMACY
EAST SYRACUSENY1305701/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.1 LOOP ROAD ATTN: PHARMACY
AUBURNNY1302101/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.3325 WEST GENESEE STREET ATTN: PHARMACY
SYRACUSENY1321901/15/201404/01/2014  07/13/2017
Contract DetailWEGMANS FOOD MARKETS, INC.2851 BROADWAY ATTN: PHARMACY
CHEEKTOWAGANY1422710/08/202001/01/2021 03/01/202103/04/2021
Contract DetailWEGMANS FOOD MARKETS, INC.2873 BROADWAY ST SUITE 100
CHEEKTOWAGANY14227-103602/26/202102/26/2021  03/01/2021
Contract DetailWESTSIDE FAMILY PHARMACY LLC216 SEYMOUR ST
SYRACUSENY13204-320801/14/202204/01/2022  04/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH330241AChildDSHUNIVERSITY HOSPITALUpstate Urology550 Harrison StreetSyracuseNYActive
DSH330241AAChildDSHUNIVERSITY HOSPITALUniversity GeriatriciansNappi Wellness InstituteSyracuseNYActive
DSH330241ABChildDSHUNIVERSITY HOSPITALUpstate University Hospital Dental ServicesUpstate Health Care CenterSyracuseNYActive
DSH330241ACChildDSHUNIVERSITY HOSPITALWomen's Health ServicesUpstate Health Care CenterSyracuseNYActive
DSH330241ADChildDSHUNIVERSITY HOSPITALAdult MedicineNappi Wellness InstituteSyracuseNYActive
DSH330241AEChildDSHUNIVERSITY HOSPITALRegional Oncology Center750 East Adams StreetSyracuseNYTerminated
DSH330241AFChildDSHUNIVERSITY HOSPITALHealth Services - Employee and Student Health175 Elizabeth Blackwell StreetSyracuseNYTerminated
DSH330241AGChildDSHUNIVERSITY HOSPITALPediatric SurgeryPhysicians Office BuildingSyracuseNYActive
DSH330241AHChildDSHUNIVERSITY HOSPITALPediatric UrologyPhysicians Office BuildingSyracuseNYActive
DSH330241AJChildDSHUNIVERSITY HOSPITALENT Clinic550 Harrison StreetSyracuseNYActive
DSH330241AKChildDSHUNIVERSITY HOSPITALWomen's Imaging 550 Harrison550 Harrison StreetSyracuseNYActive
DSH330241ALChildDSHUNIVERSITY HOSPITALUpstate Comprehensive Pain Management - CC4900 Broad RoadSyracuseNYTerminated
DSH330241AMChildDSHUNIVERSITY HOSPITALEmergency Department - CC4900 Broad RoadSyracuseNYActive
DSH330241ANChildDSHUNIVERSITY HOSPITALEpilepsy Monitoring Unit - CC4900 Broad RoadSyracuseNYTerminated
DSH330241APChildDSHUNIVERSITY HOSPITALRadiology - CC4900 Broad RoadSyracuseNYActive
DSH330241AQChildDSHUNIVERSITY HOSPITALUpstate Golisano After Hours Care - CC4900 Broad RoadSyracuseNYActive
DSH330241ARChildDSHUNIVERSITY HOSPITALRespiratory Care - CC4900 Broad RoadSyracuseNYActive
DSH330241ASChildDSHUNIVERSITY HOSPITALUpstate Vascular Surgery - CC4900 Broad RoadSyracuseNYActive
DSH330241ATChildDSHUNIVERSITY HOSPITALUpstate Bariatric, General & Thoracic Surgery - CC4900 Broad RoadSyracuseNYActive
DSH330241AUChildDSHUNIVERSITY HOSPITALUpstate Urology - CC4900 Broad RoadSyracuseNYActive
DSH330241AVChildDSHUNIVERSITY HOSPITALUpstate Midwifery and Gynecology - CC4900 Broad RoadSyracuseNYTerminated
DSH330241AWChildDSHUNIVERSITY HOSPITALWellspring Breast Cancer Center - CC4900 Broad RoadSyracuseNYActive
DSH330241AXChildDSHUNIVERSITY HOSPITALOutpatient Infusion Services - CC4900 Broad RoadSYRACUSENYActive
DSH330241AYChildDSHUNIVERSITY HOSPITALLabor and Delivery - CC4900 Broad RoadSyracuseNYActive
DSH330241AZChildDSHUNIVERSITY HOSPITALENT Clinic - CC4900 Broad RoadSYRACUSENYActive
DSH330241BChildDSHUNIVERSITY HOSPITALJoslin Diabetes CenterNappi Wellness InstituteSyracuseNYActive
DSH330241BAChildDSHUNIVERSITY HOSPITALUpstate InternistsNappi Wellness InstituteSYRACUSENYActive
DSH330241BBChildDSHUNIVERSITY HOSPITALCT SCAN - CC4900 Broad RoadSyracuseNYActive
DSH330241BCChildDSHUNIVERSITY HOSPITALUltrasound - CC4900 Broad RoadSyracuseNYActive
DSH330241BDChildDSHUNIVERSITY HOSPITALNuclear Medicine - CC4900 Broad RoadSyracuseNYActive
DSH330241BEChildDSHUNIVERSITY HOSPITALMRI - CC4900 Broad RoadSyracuseNYActive
DSH330241BFChildDSHUNIVERSITY HOSPITALStress Echo / Echocardiology - CC4900 Broad RoadSyracuseNYActive
DSH330241BGChildDSHUNIVERSITY HOSPITALUpstate Health Care Center / RadiologyUpstate Health Care CenterSyracuseNYActive
DSH330241BHChildDSHUNIVERSITY HOSPITALRadiology - 550 Harrison550 Harrison StreetSyracuseNYActive
DSH330241BJChildDSHUNIVERSITY HOSPITALAmbulatory Surgical Center - CC4900 Broad RoadSyracuseNYActive
DSH330241BKChildDSHUNIVERSITY HOSPITALPost-Op - CC4900 Broad RoadSyracuseNYActive
DSH330241BLChildDSHUNIVERSITY HOSPITALMain Operating Room - CC4900 Broad RoadSyracuseNYTerminated
DSH330241BMChildDSHUNIVERSITY HOSPITALPsychiatric Hospital - Outpatient Psychiatric Clinic - Adult713 Harrison StreetSyracuseNYActive
DSH330241BPChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 4 East PMR CC - Observation4900 Broad RoadSyracuseNYTerminated
DSH330241BQChildDSHUNIVERSITY HOSPITALFamily Medicine - Family Medicine-NAPPINappi Wellness InstituteSyracuseNYActive
DSH330241BRChildDSHUNIVERSITY HOSPITALPsychiatric Hospital - Outpatient Psychiatric Clinic - Pediatric713 Harrison StreetSyracuseNYActive
DSH330241BSChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 5 West Psychiatry CC -Observation4900 Broad RoadSyracuseNYTerminated
DSH330241BTChildDSHUNIVERSITY HOSPITALCommunity General Hospital - ICU CC -Observation4900 Broad RoadSyracuseNYActive
DSH330241BUChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 4 North Med/Surg CC - Observation4900 Broad RoadSyracuseNYActive
DSH330241BVChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 6 Med/Surg/Ortho CC - Observation4900 Broad RoadSyracuseNYActive
DSH330241BWChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 2 POSTPARTUM GYN CC - Observation4900 Broad RoadSyracuseNYActive
DSH330241BXChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 3 WEST MEDICAL CC - Observation4900 Broad RoadSyracuseNYActive
DSH330241BYChildDSHUNIVERSITY HOSPITALCommunity General Hospital - 5 East Transitional Care Unit CC - Observation4900 Broad RoadSyracuseNYTerminated
DSH330241BZChildDSHUNIVERSITY HOSPITALRadiation Oncology- Seneca Hill - Radiation Oncology105 County Route 45AOswegoNYActive
DSH330241CChildDSHUNIVERSITY HOSPITALWound Care - CC4900 Broad RoadSyracuseNYTerminated
DSH330241CAChildDSHUNIVERSITY HOSPITALJoslin Adult Center-Community Campus - Diabetes4900 Broad Road POB NorthSyracuseNYTerminated
DSH330241CBChildDSHUNIVERSITY HOSPITALRadiation Oncology-Hill Med Ct - Radiation Oncology1000 East Genesee StreetSyracuseNYActive
DSH330241CCChildDSHUNIVERSITY HOSPITALFamily Medicine- Community Campus - Primary Care/ Family and Preventive Medicine4900 Broad RoadSyracuseNYActive
DSH330241CDChildDSHUNIVERSITY HOSPITALPediatric Infectious Disease Provider-Based Clinic - Pediatric Hematology and Infectious DiseasePhysicians Office BuildingSyracuseNYActive
DSH330241CEChildDSHUNIVERSITY HOSPITALPediatric Specialty Clinic - Pediatric Pulmonary, CF and adult CF475 Irving AvenueSyracuseNYActive
DSH330241CFChildDSHUNIVERSITY HOSPITALOSWEGO HEMATOLOGY/ONCOLOGY HOSPITAL BASED CLINIC - HEMATOLOGY/ONCOLOGY140 W. 6th StreetOswegoNYActive
DSH330241CGChildDSHUNIVERSITY HOSPITALINTERVENTIONAL RADIOLOGY-COMMUNITY CAMPUS - Interventional Radiology4900 Broad RoadSyracuseNYActive
DSH330241CHChildDSHUNIVERSITY HOSPITALMEDICAL TOXICOLOGY- PROVIDER BASED NAPPI - Medical Toxicology/Bridge ClinicNappi Wellness InstituteSYRACUSENYActive
DSH330241CJChildDSHUNIVERSITY HOSPITALCENTER FOR SPECIAL NEEDS-HOSPITAL BASED - DEVELOPMENTAL EVALUATION CENTERUpstate Health Care CenterSYRACUSENYTerminated
DSH330241CKChildDSHUNIVERSITY HOSPITALGolisano Center for Special Needs - Development, Behavior, & Genetics- Provider Based475 Irving AvenueSyracuseNYActive
DSH330241CLChildDSHUNIVERSITY HOSPITALMcMahon Ryan Child Advocacy Center - C.A.R.E Clinic601 East Genesee StreetSyracuseNYActive
DSH330241CMChildDSHUNIVERSITY HOSPITALInfluenza-Like Illness Clinic - Adult and Pediatric Seasonal Clinic4900 Broad RoadSyracuseNYTerminated
DSH330241CNChildDSHUNIVERSITY HOSPITALSleep Disorder Lab at Community - Electroencephalography (EEG)4900 Broad RoadSyracuseNYActive
DSH330241CPChildDSHUNIVERSITY HOSPITALUpstate Brain & Spine Center - Neurosurgery- Provider Based CC POB4900 Broad RoadSyracuseNYActive
DSH330241CQChildDSHUNIVERSITY HOSPITAL4 West at Community-Outpatient Observation Beds - Med/Surg-ObservationUpstate University Hospital at Community CampusSyracuseNYActive
DSH330241CRChildDSHUNIVERSITY HOSPITALGynecology Oncology Hospital Based Madison Irving Med Ctr - Gynecology OncologyUpstate University HospitalSyracuseNYActive
DSH330241CSChildDSHUNIVERSITY HOSPITALUpstate Cancer Center at Community (Hospital-Based) - Hematology/OncologyUpstate University Hospital at Community CampusSyracuseNYActive
DSH330241CTChildDSHUNIVERSITY HOSPITALConnect Care Program Clinic - Continuous CareNappi Wellness InstituteSyracuseNYActive
DSH330241CUChildDSHUNIVERSITY HOSPITALCenter for International Health - Primary CareNappi Wellness InstituteSyracuseNYActive
DSH330241CVChildDSHUNIVERSITY HOSPITALBreast Care and Plastic Surgery Center (Provider-Based CC POB) - Breast Care4900 Broad RoadSyracuseNYActive
DSH330241CWChildDSHUNIVERSITY HOSPITALCARDIOLOGY PROVIDER-BASED MANLIUS - CARDIOLOGY102 West Seneca StreetManliusNYActive
DSH330241CXChildDSHUNIVERSITY HOSPITALTRANSPLANT CLINIC- PROVIDER BASED 550HAR - Transplant550 Harrison StreetSyracuseNYActive
DSH330241CYChildDSHUNIVERSITY HOSPITALUPSTATE BRAIN AND SPINE CENTER at UHCC - NEUROSURGERY-PROVIDER BASEDUpstate Health Care CenterSyracuseNYActive
DSH330241CZChildDSHUNIVERSITY HOSPITALRADIOLOGY NAPPI - Radiology ServicesNappi Wellness InstituteSyracuseNYActive
DSH330241DChildDSHUNIVERSITY HOSPITALPediatric Rheumatology and Integrative MedicinePhysicians Office BuildingSyracuseNYActive
DSH330241DAChildDSHUNIVERSITY HOSPITALHEMATOLOGY ONCOLOGY VERONA- HOSPITAL BASED - Hematology/OncologyUpstate Cancer Center at VeronaVeronaNYActive
DSH330241DBChildDSHUNIVERSITY HOSPITALUROLOGY CLINIC AT VERONA- PROVIDER BASED - UrologyUpstate Cancer Center at VeronaVeronaNYActive
DSH330241DCChildDSHUNIVERSITY HOSPITALRADIATION ONCOLOGY VERONA- HOSPITAL BASED - Rad/OncUpstate Cancer Center at VeronaVeronaNYActive
DSH330241DDChildDSHUNIVERSITY HOSPITALCONCUSSION MANAGEMENT CLINIC CLAY- HOSPITAL BASED - Psychology8687 Carling RoadLiverpoolNYActive
DSH330241DEChildDSHUNIVERSITY HOSPITALINTEGRATED CARE NAPPI- HOSPITAL BASED - Psychiatry Amb. CareNappi Wellness InstituteSyracuseNYActive
DSH330241DFChildDSHUNIVERSITY HOSPITALSurgical Subspecialties 550 Provider Based - Surgical Ambulatory Care550 Harrison StreetSyracuseNYActive
DSH330241EChildDSHUNIVERSITY HOSPITALCenter for Development, Behavior & GeneticsPhysicians Office BuildingSyracuseNYActive
DSH330241FChildDSHUNIVERSITY HOSPITALUpstate DermatologyUpstate Health Care CenterSyracuseNYActive
DSH330241GChildDSHUNIVERSITY HOSPITALUpstate Pediatrics at Baldwinsville3448 Route 31BaldwinsvilleNYActive
DSH330241HChildDSHUNIVERSITY HOSPITALUpstate Outpatient Surgery Center550 Harrison StreetSyracuseNYActive
DSH330241JChildDSHUNIVERSITY HOSPITALUpstate Ophthalmology550 Harrison StreetSyracuseNYActive
DSH330241KChildDSHUNIVERSITY HOSPITALPediatric Endocrinology Joslin ClinicNappi Wellness InstituteSyracuseNYActive
DSH330241LChildDSHUNIVERSITY HOSPITALPediatric Gastroenterology, Hepatology and NutritionPhysicians Office BuildingSyracuseNYActive
DSH330241MChildDSHUNIVERSITY HOSPITALInclusive Health ServicesNappi Wellness InstituteSyracuseNYActive
DSH330241NChildDSHUNIVERSITY HOSPITALUpstate RheumatologyUpstate Health Care CenterSyracuseNYActive
DSH330241PChildDSHUNIVERSITY HOSPITALPediatric Nephrology CenterPhysicians Office BuildingSyracuseNYActive
DSH330241QChildDSHUNIVERSITY HOSPITALUpstate Pediatric and Adolescent CenterNappi Wellness InstituteSyracuseNYActive
DSH330241RChildDSHUNIVERSITY HOSPITALBreast Care, Endocrine and Plastic Surgery Center550 Harrison StreetSyracuseNYActive
DSH330241SChildDSHUNIVERSITY HOSPITALUpstate NephrologyUpstate Health Care CenterSyracuseNYActive
DSH330241TChildDSHUNIVERSITY HOSPITALGlaucoma Clinic550 Harrison StreetSyracuseNYTerminated
DSH330241UChildDSHUNIVERSITY HOSPITALRenal ClinicUniversity Health Care CenterSyracuseNYTerminated
DSH330241WChildDSHUNIVERSITY HOSPITALPerinatal CenterUpstate Health Care CenterSyracuseNYActive
DSH330241XChildDSHUNIVERSITY HOSPITALPulmonary ClinicUpstate Health Care CenterSyracuseNYActive
DSH330241YChildDSHUNIVERSITY HOSPITALCardiology & Heart Failure CenterUpstate Health Care CenterSyracuseNYActive
DSH330241ZChildDSHUNIVERSITY HOSPITALUpstate NeurologyUpstate Health Care CenterSyracuseNYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateChange RequestSchmidt, Katie 340B Coordinator SUNY Upstate Medical University Hospital 3154644212Marzella, Amanda 340B Contract Pharmacy Manager SUNY Upstate Medical University Hospital 31546460398/27/2024 8:23 AM
DetailsLast Recertification DateUpdateRecertification8/14/2023 9:03:27 AM8/12/2024 10:10:21 AM8/12/2024 10:10 AM
DetailsLast Recertification DateUpdateRecertification8/29/2022 4:21:38 PM8/14/2023 9:03:27 AM8/14/2023 9:03 AM
AddressesShipping AddressUpdateChange RequestState University of New York- Upstate Outpatient Pharmacy at Nappi 750 East Adams Street RM 3717 Syracuse, NY 13210State University of New York- Upstate Outpatient Pharmacy at Nappi 725 East Adams Street RM 1031 Syracuse, NY 132106/10/2023 6:38 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/3/2023 10:08 AM
Medicaid BillingMedicaid: NumberInsertChange Request 073998971/3/2023 10:08 AM
Medicaid BillingMedicaid: StateInsertChange Request NY1/3/2023 10:08 AM
Medicaid BillingNPI: NumberInsertChange Request 13065674741/3/2023 10:08 AM
Medicaid BillingNPI: StateInsertChange Request NY1/3/2023 10:08 AM
AddressesShipping AddressInsertChange Request State University of New York- Upstate Outpatient Pharmacy at Nappi 750 East Adams Street RM 3717 Syracuse, NY 132109/9/2022 10:34 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 10:12:18 AM8/29/2022 4:21:38 PM8/29/2022 4:21 PM
AddressesShipping AddressUpdateChange RequestState University of New York Out-Patient Pharmacy at UHC 5000 West Seneca Turnpike STE. A Syracuse, NY 13215State University of New York Out-Patient Pharmacy at UCH 5000 West Seneca Turnpike STE. A Syracuse, NY 1321510/4/2021 11:21 AM
AddressesShipping AddressDeleteRecertificationUpstate University Hospital 750 East Adams Syracuse, NY 13210 9/9/2021 10:12 AM
AddressesShipping AddressInsertRecertification Upstate University Hospital 750 East Adams Street Syracuse, NY 132109/9/2021 10:12 AM
Medicaid BillingMedicaid: NumberDeleteRecertification00354590 (NY) 9/9/2021 10:12 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2021 10:12 AM
Medicaid BillingMedicaid: NumberInsertRecertification 030017239/9/2021 10:12 AM
Medicaid BillingMedicaid: StateInsertRecertification NY9/9/2021 10:12 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2021 10:12 AM
Medicaid BillingMedicaid: NumberInsertRecertification 065611919/9/2021 10:12 AM
Medicaid BillingMedicaid: StateInsertRecertification NY9/9/2021 10:12 AM
DetailsLast Recertification DateUpdateRecertification8/25/2020 7:03:05 PM9/9/2021 10:12:18 AM9/9/2021 10:12 AM
Medicaid BillingNPI: NumberInsertChange Request 13963309326/28/2021 9:11 AM
Medicaid BillingNPI: StateInsertChange Request NY6/28/2021 9:11 AM
AddressesShipping AddressInsertChange Request State University of New York Out-Patient Pharmacy at UHC 5000 West Seneca Turnpike STE. A Syracuse, NY 132153/11/2021 1:12 PM
ContactsAuthorizing OfficialUpdateChange RequestCorona, Robert John CEO SUNY Upstate Medical University Hospital 3154644223Wright, Stuart M. Chief Financial Officer SUNY Upstate Medical University Hospital 31546451792/4/2021 9:54 AM
AddressesMain AddressUpdateRecertification 750 EAST ADAMS ST SYRACUSE, NY 13210 750 East Adams Street Syracuse, NY 132108/25/2020 7:03 PM
Medicaid BillingNPI: StateUpdateRecertification NY8/25/2020 7:03 PM
Medicaid BillingNPI: StateUpdateRecertification NY8/25/2020 7:03 PM
DetailsLast Recertification DateUpdateRecertification8/27/2019 7:28:15 AM8/25/2020 7:03:05 PM8/25/2020 7:03 PM
DetailsLast Recertification DateUpdateRecertification8/28/2018 12:59:22 PM8/27/2019 7:28:15 AM8/27/2019 7:28 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestCorona, Robert John interim CEO SUNY Upstate Medical University Hospital 3154644223Corona, Robert John CEO SUNY Upstate Medical University Hospital 31546442231/17/2019 7:55 PM
ContactsPrimary ContactUpdateChange RequestBalotin, Eric Associate Director of Pharmacy SUNY Upstate Medical University Hospital 3154644215Schmidt, Katie 340B Coordinator SUNY Upstate Medical University Hospital 315464421212/4/2018 3:00 PM
DetailsLast Recertification DateUpdateRecertification11/8/2017 1:28:17 PM8/28/2018 12:59:22 PM8/28/2018 12:59 PM
AddressesShipping AddressDeleteChange RequestState University of New York Outpatient Pharmacy 750 East Adams Street Rm 310 A-B Syracuse, NY 13210 6/13/2018 1:56 PM
AddressesShipping AddressInsertChange Request State University of New York Outpatient Pharmacy 750 East Adams Street, Lobby Syracuse, NY 132106/13/2018 1:56 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False5/21/2018 3:35 PM
Medicaid BillingMedicaid: NumberInsertChange Request 050622535/21/2018 3:35 PM
Medicaid BillingMedicaid: StateInsertChange Request NY5/21/2018 3:35 PM
Medicaid BillingNPI: NumberInsertChange Request 17407966975/21/2018 3:35 PM
ContactsPrimary ContactUpdateChange RequestRichardson, Kimberly 340B Compliance Manager University Hospital 3154644212Balotin, Eric Associate Director of Pharmacy SUNY Upstate Medical University Hospital 31546442155/18/2018 2:32 PM
ContactsAuthorizing OfficialUpdateChange RequestScott, Steven Chief Executive Officer Upstate University Hospital 3154644223Corona, Robert John interim CEO SUNY Upstate Medical University Hospital 31546442234/13/2018 12:41 PM
AddressesShipping AddressInsertChange Request State University of New York Outpatient Pharmacy 750 East Adams Street Rm 310 A-B Syracuse, NY 132101/10/2018 3:16 PM
DetailsLast Recertification DateUpdateRecertification10/25/2017 2:29:08 PM11/8/2017 1:28:17 PM11/8/2017 1:28 PM
DetailsLast Recertification DateUpdateRecertification8/30/2016 12:00:00 AM10/25/2017 2:29:08 PM10/25/2017 2:29 PM
ContactsAuthorizing OfficialUpdate Scott, Steven Chief Executive Officer 3154644223Scott, Steven Chief Executive Officer Upstate University Hospital 315464422310/20/2017 3:26 PM
ContactsPrimary ContactUpdate Richardson, Kimberly 340B Compliance Manager 3154644212Richardson, Kimberly 340B Compliance Manager University Hospital 31546442129/20/2017 9:00 AM
AddressesMain AddressInsert   750 EAST ADAMS ST SYRACUSE, NY 132107/25/2017 7:34 AM
AddressesBilling AddressInsert  Upstate University Hospital 750 East Adams Street Syracuse, NY 132107/25/2017 7:34 AM
AddressesShipping AddressInsert  Upstate University Hospital 750 East Adams Syracuse, NY 132107/25/2017 7:34 AM
AddressesShipping AddressInsert  Upstate University Hospital 117 Monroe Street SYRACUSE, NY 132107/25/2017 7:34 AM
AddressesShipping AddressInsert  Upstate University Hospital at Community 4900 Broad Road Syracuse, NY 132157/25/2017 7:34 AM
ContactsPrimary ContactUpdate Boggs, Kimberly 340B Program Coordinator 3154644212Richardson, Kimberly 340B Compliance Manager 31546442127/25/2017 7:34 AM
ContactsAuthorizing OfficialUpdate McCabe, John Chief Executive Officer 3154644223Scott, Steven Chief Executive Officer 31546442237/25/2017 7:34 AM
ContactsPrimary ContactUpdate Ciullo, Steven Director of Pharmacy 3154644215Boggs, Kimberly 340B Program Coordinator 315464421210/13/2016 9:11 AM
DetailsLast Recertification DateUpdate 8/27/2015 12:00:00 AM8/30/2016 12:00:00 AM8/30/2016 4:37 PM
ContactsPrimary ContactUpdate GUHAROY, ROY DIRECTOR OF PHARMACY SERVICES 3154644311Ciullo, Steven Director of Pharmacy 31546442155/18/2016 12:12 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/27/2015 4:05 PM
DetailsLast Recertification DateUpdate 8/8/2014 12:00:00 AM8/27/2015 12:00:00 AM8/27/2015 4:05 PM
ContactsAuthorizing OfficialUpdate DONOVAN, TOM CFO 3154646530McCabe, John Chief Executive Officer 315464422311/28/2014 2:15 PM
DetailsLast Recertification DateUpdate 8/22/2013 12:00:00 AM8/8/2014 12:00:00 AM8/8/2014 11:52 AM
Medicaid BillingNPI: NumberInsert  15785546308/22/2013 12:53 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/22/2013 12:00:00 AM8/22/2013 12:53 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/16/2012 8:13 AM
DatesParticipating Approval DateUpdate 6/21/2005 6:39:52 AM6/21/2005 12:00:00 AM3/26/2012 3:47 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True7/1/2005 12:00 AM
Medicaid BillingMedicaid: NumberInsert  003545907/1/2005 12:00 AM
Medicaid BillingMedicaid: StateInsert  NY7/1/2005 12:00 AM
ContactsPrimary ContactInsert  GUHAROY, ROY DIRECTOR OF PHARMACY SERVICES 31546443117/1/2005 12:00 AM
ContactsAuthorizing OfficialInsert  DONOVAN, TOM CFO 31546465307/1/2005 12:00 AM
DetailsLast Recertification DateInsert   6/21/2005 6:39 AM
DetailsGrant NumberInsert   6/21/2005 6:39 AM
Details340B IDInsert  DSH3302416/21/2005 6:39 AM
DetailsIs Authorizing Official EHB DataInsert   6/21/2005 6:39 AM
DatesLast Date That 340B Drugs PurchasedInsert   6/21/2005 6:39 AM
DetailsMedicare Provider NumberInsert  3302416/21/2005 6:39 AM
DetailsEntity NameInsert  UNIVERSITY HOSPITAL6/21/2005 6:39 AM
DetailsProgram CodeInsert  DSH6/21/2005 6:39 AM
DetailsEntity SubnameInsert   6/21/2005 6:39 AM
DatesParticipating Approval DateInsert  6/21/2005 6:39:52 AM6/21/2005 6:39 AM
DetailsStateInsert  Active6/21/2005 6:39 AM
DatesRegistration DateInsert  7/1/2005 12:00:00 AM6/21/2005 6:39 AM
DatesSigned By DateInsert  5/25/2005 12:00:00 AM6/21/2005 6:39 AM
DatesStart DateInsert  7/1/2005 12:00:00 AM6/21/2005 6:39 AM
TerminationsTermination CommentsInsert   6/21/2005 6:39 AM
TerminationsTermination DateInsert   6/21/2005 6:39 AM
TerminationsTermination Effective DateInsert   6/21/2005 6:39 AM
TerminationsTermination ReasonInsert   6/21/2005 6:39 AM
DetailsComments PublicInsert  NEW ADD 7/056/21/2005 6:39 AM