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KPH HEALTHCARE SERVICES, INC.
CAH331317-00 LEWIS COUNTY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LEWIS COUNTY GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331317-00
Entity Address
7785 NORTH STATE STREET
LOWVILLE, NY 13367
Medicare Provider Number
331317
Participating Start Date
10/1/2014
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #20
7395 UTICA BLVD
LOWVILLE, NY 13367
Pharmacy Comments
Contract Details
Approval Date
9/25/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Burch, CEO
(315) 376-5203
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
9/25/2014
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