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KPH HEALTHCARE SERVICES, INC.
CH02124D FAMILY HEALTH NETWORK OF CENTRAL NEW YORK INC
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Covered Entity Details
Entity Name
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK INC
Subdivision Name
MORAVIA MEDICAL OFFICE
Type
HRSA-Funded Health Center
340B ID
CH02124D
Entity Address
23 CENTRAL STREET
MORAVIA, NY 13118-3599
Grant Number
H80CS00065
Participating Start Date
1/1/1997
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #82
44 NORTH STREET
DRYDEN, NY 13053
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Marie Osborne, Chief Executive Officer
(607) 753-3797
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/8/2024
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