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KPH HEALTHCARE SERVICES, INC.
CH010640 NORTHERN COUNTIES HEALTH CARE, INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE, INC
Subdivision Name
NORTHERN COUNTIES HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CH010640
Entity Address
165 Sherman Dr
Saint Johnsbury, VT 05819-9811
Grant Number
H80CS00632
Participating Start Date
9/1/2008
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #120
12 RAILROAD ST
ISLAND POND, VT 05846-9716
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Patrick Flood, CEO
(802) 748-9405 Ext: 1519
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
10/14/2014
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