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AVELLA OF ST LOUIS
DSH150007 COMMUNITY HOWARD REGIONAL HEALTH
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Covered Entity Details
Entity Name
COMMUNITY HOWARD REGIONAL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150007
Entity Address
3500 SOUTH LAFOUNTAIN
KOKOMO, IN 46902
Medicare Provider Number
150007
Participating Start Date
1/1/2016
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
11/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Joseph Hooper, President & CEO
(765) 776-8580
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/12/2019
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