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STATE UNIVERSITY OF NEW YORK
CH02016F SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Westside Academy at Blodgett 312 Oswego Street
Type
HRSA-Funded Health Center
340B ID
CH02016F
Entity Address
312 Oswego Street
Syracuse, NY 13204
Grant Number
H80CS00434
Participating Start Date
7/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
STATE UNIVERSITY OF NEW YORK
Pharmacy Address
OUTPATIENT PHARMACY
750 E ADAMS ST LOBBY
SYRACUSE, NY 13210
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
7/1/2019
Contract Comments
Contract Termination Date
Termination Reason
2/18/2021
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
SUNY Upstate Medical University Hospital
Eric Balotin, Associate Director of Pharmacy
(315) 464-4215
Signed By Date
4/15/2019
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