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FQHCLA360D Upstate Family Health Center, Inc. (Terminated)
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Main Details
Name
Upstate Family Health Center, Inc.
Subdivision Name
Upstate Family Health Center, Inc. MLK SBHC
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-021455
340B ID
FQHCLA360D
Grant Number
LALCS31538
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/13/2018
Last Recertification Date
1/28/2020
Termination Date
Termination Reason
7/1/2020
Change of covered entity type (non-hospital)
Contacts
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
Addresses
Street Address
Martin Luther King Jr. Elementary 211 Square Street
Utica, NY 13501-4551
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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