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KPH HEALTHCARE SERVICES, INC.
CH011223B COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Subdivision Name
BRANDON INTERNAL MEDICINE
Type
HRSA-Funded Health Center
340B ID
CH011223B
Entity Address
420 Grove St
Brandon, VT 05733-9062
Grant Number
H80CS06659
Participating Start Date
7/1/2006
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #98
34 ROUTE 30 NORTH
BOMOSEEN, VT 05732
Pharmacy Comments
12/11/2012 address line 1 update (was ROUTE 30)
Contract Details
Approval Date
10/19/2012
Contract Begin Date
10/19/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Gardner, CEO
(802) 855-2083
Contract Pharmacy Representative
Stephen McCoy, Cheif Financial Officer
(315) 287-3600
Signed By Date
9/14/2012
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