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KPH HEALTHCARE SERVICES, INC.
DSH330241 UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330241
Entity Address
750 East Adams Street
Syracuse, NY 13210
Medicare Provider Number
330241
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
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
10/3/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Seale, Chief Operating Officer
(315) 464-6530
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
10/3/2013
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