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KPH HEALTHCARE SERVICES, INC.
RWII13204 AIDS Community Resources, Inc.
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Covered Entity Details
Entity Name
AIDS Community Resources, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII13204
Entity Address
627 West Genesee Street
Syracuse, NY 13204
Grant Number
X07HA00025-34-01
Participating Start Date
1/1/2014
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #43
21 E. GENESEE STREET
BALDWINSVILLE, NY 13027
Pharmacy Comments
06/24/2010 - PHYSICAL ADDRESS CHANGED FROM 31 E GENESEE ST. DUE TO "911" CHANGE.
Contract Details
Approval Date
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marissa Rice, Executive Director
(315) 475-2430
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
4/19/2021
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