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KPH HEALTHCARE SERVICES, INC.
SCH330235-00 AUBURN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
AUBURN COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330235-00
Entity Address
17 LANSING STREET
AUBURN, NY 13021
Medicare Provider Number
330235
Participating Start Date
10/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #73
130 MAIN STREET
MORAVIA, NY 13118
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Trisha Koczent, CFO
(315) 255-7231
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
1/15/2020
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