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KPH HEALTHCARE SERVICES, INC.
DSH330136 MARY IMOGENE BASSETT HOSPITAL
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Covered Entity Details
Entity Name
MARY IMOGENE BASSETT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330136
Entity Address
1 ATWELL ROAD
COOPERSTOWN, NY 13326
Medicare Provider Number
330136
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #27
40 FIRST STREET
ILION, NY 13357
Pharmacy Comments
Contract Details
Approval Date
4/29/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Vielkind, Vice President Finance
(315) 823-5281
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
4/13/2025
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