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KPH HEALTHCARE SERVICES, INC.
CAH471303-00 NORTHEASTERN VERMONT REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
NORTHEASTERN VERMONT REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471303-00
Entity Address
1315 HOSPITAL DRIVE
ST JOHNSBURY, VT 05819
Medicare Provider Number
471303
Participating Start Date
9/28/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #58
55 SHATTUCK HILL ROAD
NEWPORT, VT 05855
Pharmacy Comments
04/12/2012 address correction (was 55 Shattuck Hilld Rd.)
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Hersey, CFO
(802) 748-7530
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
10/14/2022
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