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WALGREEN EASTERN CO., INC.
CHC33656-02 Upstate Family Health Center, Inc.
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Covered Entity Details
Entity Name
Upstate Family Health Center, Inc.
Subdivision Name
Upstate Family Health Center, Inc. Donovan SBHC
Type
HRSA-Funded Health Center
340B ID
CHC33656-02
Entity Address
1701 Noyes St
Utica, NY 13502-3857
Grant Number
H80CS33656
Participating Start Date
7/1/2020
Last Recertification Date
2/6/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #10159
201 S. JAMES ST.
ROME, NY 13440
Pharmacy Comments
Contract Details
Approval Date
4/16/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John Milligan, Chief Executive Officer
(315) 624-9470 Ext: 260
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2020
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