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KPH HEALTHCARE SERVICES, INC.
CAH331316-00 COMMUNITY MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331316-00
Entity Address
150 BROAD ST
HAMILTON, NY 13346
Medicare Provider Number
331316
Participating Start Date
4/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #68
103 UTICA ST
HAMILTON, NY 13346
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sean Fadale, President and CEO
(315) 824-6080
Contract Pharmacy Representative
Kinney Drugs
Debbi Barber, Director of Pharmacy Programs
(315) 287-3600 Ext: 2423
Signed By Date
4/14/2015
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