340B Drug Pricing Program Database
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KPH HEALTHCARE SERVICES, INC.
CAH331316-00 COMMUNITY MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331316-00
Entity Address
150 BROAD ST
HAMILTON, NY 13346
Medicare Provider Number
331316
Participating Start Date
4/1/2015
Last Recertification Date
8/15/2024
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
7/16/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/19/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carrie Bova, Senior Director of Business Devolpment
(315) 824-6560
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/16/2024
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