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AVELLA OF COLUMBUS
DSH390090 West Penn Hospital
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Covered Entity Details
Entity Name
West Penn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390090
Entity Address
4800 FRIENDSHIP AVE
PITTSBURGH, PA 15224-1722
Medicare Provider Number
390090
Participating Start Date
10/20/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
AVELLA OF COLUMBUS
Pharmacy Address
4830 KNIGHTSBRIDGE BLVD STE C
COLUMBUS, OH 43214-2300
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Ron Andro, President and CEO
(412) 578-1176
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/17/2017
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