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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
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
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
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
10/15/2019
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