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PARKWAY DRUGS OF ONEIDA COUNTY NORTH, IN
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
PARKWAY DRUGS OF ONEIDA COUNTY NORTH, IN
Pharmacy Address
350 LELAND AVENUE
UTICA, NY 13502
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
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
Parkway Drugs
Tony Chiffy, VP
(315) 735-3525
Signed By Date
4/13/2018
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