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CVS ALBANY, L.L.C.
CH02016M SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Onondaga Community College
Type
HRSA-Funded Health Center
340B ID
CH02016M
Entity Address
4585 W Seneca Tpke
Syracuse, NY 13215-4580
Grant Number
H80CS00434
Participating Start Date
8/20/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CVS ALBANY, L.L.C.
Pharmacy Address
CVS/PHARMACY # 16808
340 TOWNE DR
FAYETTEVILLE, NY 13066
Pharmacy Comments
Contract Details
Approval Date
7/27/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/23/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Derrick Murry, Chief Operating Officer
(315) 476-7921 Ext: 5942
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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