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WALGREEN EASTERN CO., INC.
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
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
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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