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SYRACUSE COMMUNITY HEALTH PHARMACY LLC
CH02016N SYRACUSE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SYRACUSE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Temporary Site - Catholic Charities Mens Shelter
Type
HRSA-Funded Health Center
340B ID
CH02016N
Entity Address
1074 S Clinton St
Syracuse, NY 13202-3409
Grant Number
H80CS00434
Participating Start Date
8/25/2020
Last Recertification Date
2/24/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
SYRACUSE COMMUNITY HEALTH PHARMACY LLC
Pharmacy Address
819 S SALINA ST STE B
SYRACUSE, NY 13202-3527
Pharmacy Comments
Contract Details
Approval Date
9/2/2020
Contract Begin Date
9/3/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy C Ellingworth, CFO
(315) 476-7921 Ext: 2260
Contract Pharmacy Representative
Pharmacy Specialist Group II Inc
Praveen Challa, Pharmacist
(718) 783-0890
Signed By Date
9/2/2020
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