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WESTSIDE FAMILY PHARMACY LLC
CH02016L SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
DR. KING ELEMENTARY SBHC
Type
HRSA-Funded Health Center
340B ID
CH02016L
Entity Address
416 E RAYNOR AVE
SYRACUSE, NY 13202-3951
Grant Number
H80CS00434
Participating Start Date
7/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WESTSIDE FAMILY PHARMACY LLC
Pharmacy Address
216 SEYMOUR ST
SYRACUSE, NY 13204-3208
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
10/1/2019
Contract Comments
Contacts
Covered Entity Signing Official
Derrick Murry, Chief Operating Officer
(315) 476-7921 Ext: 5942
Contract Pharmacy Representative
Pharmacy Specialist Group II Inc
Praveen Challa, Pharmacist
(718) 783-0890
Signed By Date
4/15/2019
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