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TRILLIUM HEALTH, INC.
CH02016C SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
SCHC WEST HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH02016C
Entity Address
603 Oswego St
Syracuse, NY 13204-3127
Grant Number
H80CS00434
Participating Start Date
7/1/2017
Last Recertification Date
2/10/2025
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
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
10/1/2019
Contract Comments
Contract Termination Date
Termination Reason
2/6/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Derrick Murry, Chief Operating Officer
(315) 476-7921 Ext: 5942
Contract Pharmacy Representative
Trillium Health
MARK Joseph MALAHOSKY, VP PHARMACY SERVICES
(585) 210-4152
Signed By Date
4/15/2019
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