Contract Pharmacy Details

AVELLA OF ST LOUIS
DSH150074 Community Health Network, Inc.

Covered Entity Details

Entity Name

Community Health Network, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150074

Entity Address

1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219

Medicare Provider Number

150074

Participating Start Date

4/1/2008

Last Recertification Date

8/12/2024

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

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

David Kiley, President
(317) 621-9337

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677

Signed By Date

4/12/2019

340B Drug Pricing Program Database