340B Drug Pricing Program Database
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DSH060103A AdventHealth Avista (Active)
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Main Details
Name
AdventHealth Avista
Subdivision Name
AdventHealth Surgery Center Boulder
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060103A
Medicare Provider Number
060103
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2012
Participating Start Date
10/1/2012
Participating Approval Date
8/21/2012
Last Recertification Date
8/31/2024
Contacts
Authorizing Official
AdventHealth
Jonathan Erickson, Avista CFO
(303) 673-1000
Primary Contact
AdventHealth
Dustin Lott Jones, 340B Coordinator
(254) 833-1495
Addresses
Street Address
2525 4th Street
Suite 201
Boulder, CO 80304
Billing Address
AdventHealth Avista
c/o AdventHealth
902 Inspiration Avenue
Suite 9100
Altamonte Springs, FL 32714
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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