Contract Pharmacy Details

UPSTATE FAMILY DRUGS LLC
CHC33656-04 Upstate Family Health Center, Inc.

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

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

7/1/2024
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

340B Drug Pricing Program Database