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AVELLA OF ST LOUIS
CHC26598-00 Maury Regional Hospital
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Covered Entity Details
Entity Name
Maury Regional Hospital
Subdivision Name
Lewis Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26598-00
Entity Address
617 W Main St
Hohenwald, TN 38462-1355
Grant Number
H80CS26598
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVELLA OF ST LOUIS
Pharmacy Address
450 N NEW BALLAS RD STE 256
SAINT LOUIS, MO 63141-6836
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/23/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Deborah Lumpkins, Sr. VP/CNO
(931) 490-7118
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
10/15/2018
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