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AVELLA OF SCOTTSDALE
DSH030002 Banner – University Medical Center Phoenix
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Covered Entity Details
Entity Name
Banner – University Medical Center Phoenix
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030002
Entity Address
1111 EAST MCDOWELL ROAD
PHOENIX, AZ 85006
Medicare Provider Number
030002
Participating Start Date
9/9/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
AVELLA OF SCOTTSDALE
Pharmacy Address
9777 N 91ST ST #C102
SCOTTSDALE, AZ 85258
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Cliff Loader, Chief Financial Officer
(602) 839-2675
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/15/2015
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