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WESTSIDE FAMILY PHARMACY LLC
RWII13204 AIDS Community Resources, Inc.
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Covered Entity Details
Entity Name
AIDS Community Resources, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII13204
Entity Address
627 West Genesee Street
Syracuse, NY 13204
Grant Number
X07HA00025-34-01
Participating Start Date
1/1/2014
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WESTSIDE FAMILY PHARMACY LLC
Pharmacy Address
216 SEYMOUR ST
SYRACUSE, NY 13204-3208
Pharmacy Comments
Contract Details
Approval Date
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marissa Rice, Executive Director
(315) 475-2430
Contract Pharmacy Representative
Westside Family Pharmacy
Praveen Challa, 340B Contact
(315) 928-6333
Signed By Date
4/19/2021
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