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KPH HEALTHCARE SERVICES, INC.
CH02087H NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
Subdivision Name
HLTH CTR AT PULASKI JR/SR. HIGH
Type
HRSA-Funded Health Center
340B ID
CH02087H
Entity Address
4624 SALINA ST
PULASKI, NY 13142-2102
Grant Number
H80CS00166
Participating Start Date
1/14/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #47
3318 MAIN STREET
MEXICO, NY 13114
Pharmacy Comments
04/09/2012 city correction (was mexicon)
Contract Details
Approval Date
1/24/2013
Contract Begin Date
1/24/2013
Carve-In Effective Date
Contract Comments
01/24/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contacts
Covered Entity Signing Official
Daniel T. Dey, CEO
(315) 298-6569 Ext: 2003
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
1/18/2013
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