340B Drug Pricing Program Database

Name

Upstate Family Health Center, Inc.

Subdivision Name

Upstate Family Health Center, Inc. Rome

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-021447

340B ID

FQHCLA360C

Grant Number

LALCS31538

Current Program Status

Terminated

Registration Date

1/5/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/5/2018

Last Recertification Date

1/28/2020

Termination Date
Termination Reason

7/1/2020
Change of covered entity type (non-hospital)

Authorizing Official

Upstate Family Health Center, Inc.
Jaime Oot, Director of Administration
(315) 624-9470 Ext: 2260

Primary Contact

Upstate Family Health Center
Wanda Schmidt, Operations Manager
(315) 507-2081

Street Address

205 West Dominick Street Suite A
Rome, NY 13440-5811

Billing Address
Same as Street Address