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AVELLA OF DEER VALLEY, INC. #38
CAH181311-00 ST ELIZABETH HEALTHCARE GRANT COUNTY
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Covered Entity Details
Entity Name
ST ELIZABETH HEALTHCARE GRANT COUNTY
Subdivision Name
ST ELIZABETH GRANT COUNTY
Type
Critical Access Hospital
340B ID
CAH181311-00
Entity Address
238 BARNES RD
WILLIAMSTOWN, KY 41097
Medicare Provider Number
181311
Participating Start Date
10/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
AVELLA OF DEER VALLEY, INC. #38
Pharmacy Address
DBA AVELLA SPECIALTY PHARMACY
24416 N. 19TH AVE
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lori Ritchey-Baldwin, CFO
(859) 655-1642
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/15/2019
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