Contract Pharmacy Details

CVS ALBANY, L.L.C.
CH02016F SYRACUSE COMMUNITY HEALTH CENTER, INC.

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 ALBANY, L.L.C.

Pharmacy Address

CVS/PHARMACY # 16808
340 TOWNE DR
FAYETTEVILLE, NY 13066

Pharmacy Comments

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

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

10/15/2019

340B Drug Pricing Program Database