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SYRACUSE COMMUNITY HEALTH PHARMACY LLC
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
SYRACUSE COMMUNITY HEALTH PHARMACY LLC
Pharmacy Address
819 S SALINA ST STE B
SYRACUSE, NY 13202-3527
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
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
7/11/2019
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