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WALGREEN EASTERN CO., INC
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
WALGREEN EASTERN CO., INC
Pharmacy Address
WALGREENS #19049
2616 BREWERTON RD
MATTYDALE, NY 13211
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
4/3/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Derrick Murry, Chief Operating Officer
(315) 476-7921 Ext: 5942
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2019
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