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KPH HEALTHCARE SERVICES, INC.
DSH330044 MVHS, Inc. DBA: Wynn Hospital
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Covered Entity Details
Entity Name
MVHS, Inc. DBA: Wynn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330044
Entity Address
111 Hospital Drive
Utica, NY 13502
Medicare Provider Number
330044
Participating Start Date
7/1/2014
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #49
530 ALBANY ST
LITTLE FALLS, NY 13365
Pharmacy Comments
Contract Details
Approval Date
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213
Contract Pharmacy Representative
KPH Heathcare Services
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
4/17/2025
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