340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN EASTERN CO., INC.
FQHCLA360 Upstate Family Health Center, Inc.
Print
Covered Entity Details
Entity Name
Upstate Family Health Center, Inc.
Subdivision Name
Upstate Family Health Center, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA360
Entity Address
1001 Noyes Street
Utica, NY 13502-4400
Grant Number
LALCS31538
Participating Start Date
4/1/2018
Last Recertification Date
1/28/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WLAGREENS # 18376
205 S CAROLINE ST
HERKIMER, NY 13350-2248
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jaime Oot, Project Manager
(315) 624-9470 Ext: 260
Contract Pharmacy Representative
Walgreen
krystal mobley, Sr Analyst
(847) 964-8918
Signed By Date
1/14/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session