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KPH HEALTHCARE SERVICES, INC.
CAH471307-00 Porter Hospital
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Covered Entity Details
Entity Name
Porter Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471307-00
Entity Address
115 PORTER DRIVE
MIDDLEBURY, VT 05753
Medicare Provider Number
471307
Participating Start Date
9/27/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #22
115B MONKTON ROAD
VERGENNES, VT 05491
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
5/2/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
4/29/2011
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