Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
DSH310027 TRINITAS REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

TRINITAS REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH310027

Entity Address

225 WILLIAMSON ST
ELIZABETH, NJ 07202

Medicare Provider Number

310027

Participating Start Date

1/1/2005

Last Recertification Date

9/1/2024

Pharmacy Details

Pharmacy Name

AVELLA OF DEER VALLEY, INC. #38

Pharmacy Address

DBA AVELLA SPECIALTY PHARMACY
24416 N. 19TH AVE
PHOENIX, AZ 85085

Pharmacy Comments

Contract Details

Approval Date

7/18/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/6/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

KAREN LUMPP, CFO & SENIOR VP
(908) 994-8174

Contract Pharmacy Representative

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

Signed By Date

7/18/2017

340B Drug Pricing Program Database