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KPH HEALTHCARE SERVICES, INC.
CAH471304-00 NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
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Covered Entity Details
Entity Name
NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471304-00
Entity Address
189 PROUTY DRIVE
NEWPORT, VT 05855
Medicare Provider Number
471304
Participating Start Date
9/28/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
DBA: KINNEY DRUGS CF
471 E MAIN ST
UNIT 5
GOUVERNEUR, NY 13642
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tracey L. Paul, CFO
(802) 334-3271 Ext: 271
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, VP of Managed Care Contracting and Payor Relations
(315) 413-7800 Ext: 3205
Signed By Date
7/3/2024
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