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KPH HEALTHCARE SERVICES, INC.
CAH471304-00 NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
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Covered Entity Details
Entity Name
NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471304-00
Entity Address
189 PROUTY DRIVE
NEWPORT, VT 05855
Medicare Provider Number
471304
Participating Start Date
9/28/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #105
16 CHURCH STREET
BARTON, VT 05822-8511
Pharmacy Comments
Contract Details
Approval Date
3/23/2012
Contract Begin Date
3/23/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANDRE BISSONETTE, V.P. FINANCE (C.F.O.)
(802) 334-3253
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
3/8/2012
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