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WALGREEN EASTERN CO., INC.
CHC33656-04 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. Rome
Type
HRSA-Funded Health Center
340B ID
CHC33656-04
Entity Address
205 West Dominick Street Suite A
Rome, NY 13440-5811
Grant Number
H80CS33656
Participating Start Date
7/1/2020
Last Recertification Date
2/6/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21158
33 NEW SCOTLAND AVE STE 106
ALBANY, NY 12208
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
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John Milligan, Chief Executive Officer
(315) 624-9470 Ext: 260
Contract Pharmacy Representative
Walgreen
krystal mobley, Sr Analyst
(847) 964-8918
Signed By Date
4/16/2020
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