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KPH HEALTHCARE SERVICES, INC.
CH01064L NORTHERN COUNTIES HEALTH CARE INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE INC
Subdivision Name
Orleans Dental Center
Type
HRSA-Funded Health Center
340B ID
CH01064L
Entity Address
11 Union St
Orleans, VT 05860-1218
Grant Number
H80CS00632
Participating Start Date
10/1/2022
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #106
471 EAST MAIN STREET SUITE 2
GOUVERNEUR, NY 13642
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Neil, CFO
(802) 748-9405 Ext: 1599
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/10/2024
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