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KPH HEALTHCARE SERVICES, INC.
CAH331309-00 River Hospital, Inc.
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Covered Entity Details
Entity Name
River Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331309-00
Entity Address
4 Fuller Street
Alexandria Bay, NY 13607
Medicare Provider Number
331309
Participating Start Date
4/1/2014
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #48
822 JAMES STREET
CLAYTON, NY 13624
Pharmacy Comments
Contract Details
Approval Date
3/21/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Traci Mintonye, Chief Financial Officer
(315) 482-1142
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
3/19/2014
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