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CVS ALBANY, L.L.C.
CH02016J SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
SCHC SOUTH SITE
Type
HRSA-Funded Health Center
340B ID
CH02016J
Entity Address
1701 SOUTH AVE
SYRACUSE, NY 13207-2004
Grant Number
H80CS00434
Participating Start Date
7/1/2017
Last Recertification Date
3/1/2021
Entity Termination Date
1/1/2022
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
1/1/2022
Covered Entity Terminated
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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