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UPSTATE FAMILY DRUGS LLC
CHC33656-00 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. MLK SBHC
Type
HRSA-Funded Health Center
340B ID
CHC33656-00
Entity Address
Martin Luther King Jr. Elementary 211 Square Street
Utica, NY 13501-4551
Grant Number
H80CS33656
Participating Start Date
7/1/2020
Last Recertification Date
2/2/2024
Entity Termination Date
4/1/2025
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
4/1/2025
Covered Entity Terminated
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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