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KPH HEALTHCARE SERVICES, INC.
CH01064A NORTHERN COUNTIES HEALTH CARE, INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE, INC
Subdivision Name
ISLAND POND HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01064A
Entity Address
82 MAPLE STREET
ISLAND POND, VT 05846-0425
Grant Number
H80CS00632
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #94
407 BROAD STREET
LYNDONVILLE, VT 05851
Pharmacy Comments
Contract Details
Approval Date
7/6/2012
Contract Begin Date
7/6/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Pitts, CFO
(802) 748-9405 Ext: 1599
Contract Pharmacy Representative
Debbie Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
6/29/2012
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