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KPH HEALTHCARE SERVICES, INC.
CH01064A NORTHERN COUNTIES HEALTH CARE, INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE, INC
Subdivision Name
ISLAND POND HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01064A
Entity Address
82 MAPLE STREET
ISLAND POND, VT 05846-0425
Grant Number
H80CS00632
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
DBA: KINNEY DRUGS CF
471 E MAIN ST
UNIT 5
GOUVERNEUR, NY 13642
Pharmacy Comments
Contract Details
Approval Date
1/6/2025
Contract Begin Date
1/6/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Neil, CFO
(802) 748-9405 Ext: 1599
Contract Pharmacy Representative
Northern Counties Health Care
Angela Neil, CFO
(802) 748-9405 Ext: 1599
Signed By Date
1/6/2025
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