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CVS ALBANY, L.L.C.
CH020160 SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH020160
Entity Address
819 S Salina St
Syracuse, NY 13202-3527
Grant Number
H80CS00434
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
CVS/PHARMACY # 16808
340 TOWNE DR
FAYETTEVILLE, NY 13066
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
10/1/2019
Contract Comments
Contract Termination Date
Termination Reason
7/23/2021
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2019
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