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KPH HEALTHCARE SERVICES, INC.
CH02179AK HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Hudson Headwaters Family Health at Lake Placid
Type
HRSA-Funded Health Center
340B ID
CH02179AK
Entity Address
203 Old Military Rd
Lake Placid, NY 12946
Grant Number
H80CS00159
Participating Start Date
10/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #95
1954 SARANAC AVENUE
LAKE PLACID, NY 12946
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Pasco, EVP, Chief Financial Officer
(518) 761-0300 Ext: 31553
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
10/10/2024
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