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KPH HEALTHCARE SERVICES, INC.
CHC24165-09 North Country Family Health Center, Inc.
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Covered Entity Details
Entity Name
North Country Family Health Center, Inc.
Subdivision Name
JCC Health & Wellness Center
Type
HRSA-Funded Health Center
340B ID
CHC24165-09
Entity Address
1220 Coffeen St Bldg 17
Watertown, NY 13601-1822
Grant Number
H80CS24165
Participating Start Date
7/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #30
905 COFFEEN STREET
WATERTOWN, NY 13601
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joey Marie Horton, Chief Executive Officer
(315) 782-9450
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
10/11/2024
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