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UPSTATE FAMILY DRUGS LLC
CHC33656-03 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.
Type
HRSA-Funded Health Center
340B ID
CHC33656-03
Entity Address
1001 Noyes St
Utica, NY 13502-4400
Grant Number
H80CS33656
Participating Start Date
7/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
UPSTATE FAMILY DRUGS LLC
Pharmacy Address
1001 NOYES ST
UTICA, NY 13502-4400
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
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Milligan, Chief Executive Officer
(315) 624-9470 Ext: 260
Contract Pharmacy Representative
Upstate Family Drugs
Mallika Kopalle, Owner
(732) 678-8459
Signed By Date
4/16/2020
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