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KPH HEALTHCARE SERVICES, INC.
CH02179I HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Moriah Health Center
Type
HRSA-Funded Health Center
340B ID
CH02179I
Entity Address
33 TOM PHELPS LANE
MINEVILLE, NY 12956
Grant Number
H80CS00159
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #104
161 CAREY RD STE 161B
QUEENSBURY, NY 12804
Pharmacy Comments
Contract Details
Approval Date
5/18/2012
Contract Begin Date
5/18/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
5/8/2012
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