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WALGREEN EASTERN CO., INC.
FQHCLA360C 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. Rome
Type
Health Center Program Look-Alike
340B ID
FQHCLA360C
Entity Address
205 West Dominick Street Suite A
Rome, NY 13440-5811
Grant Number
LALCS31538
Participating Start Date
4/1/2018
Last Recertification Date
1/28/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #10781
1503 GENESEE ST
UTICA, NY 13501-4709
Pharmacy Comments
Contract Details
Approval Date
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Terry Phillips, Chief Executive Officer
(315) 624-9470 Ext: 266
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/6/2018
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