340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVELLA OF ORLANDO
DSH140054 MACNEAL HOSPITAL
Print
Covered Entity Details
Entity Name
MACNEAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140054
Entity Address
3249 SOUTH OAK PARK AVENUE
BERWYN, IL 60402
Medicare Provider Number
140054
Participating Start Date
1/1/2019
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
AVELLA OF ORLANDO
Pharmacy Address
100 TECHNOLOGY PARK STE 155
LAKE MARY, FL 32746-6205
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Paul Isacksen, EVP and Regional CFO
(708) 216-4252
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/9/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session