Contract Pharmacy Details

PARKWAY DRUGS OF ONEIDA COUNTY NORTH, IN
FQHCLA360D Upstate Family Health Center, Inc.

Covered Entity Details

Entity Name

Upstate Family Health Center, Inc.

Subdivision Name

Upstate Family Health Center, Inc. MLK SBHC

Type

Health Center Program Look-Alike

340B ID

FQHCLA360D

Entity Address

Martin Luther King Jr. Elementary 211 Square Street
Utica, NY 13501-4551

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

340B Drug Pricing Program Database