Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
DSH330005 KALEIDA HEALTH

Covered Entity Details

Entity Name

KALEIDA HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330005

Entity Address

100 High Street
BUFFALO, NY 14203

Medicare Provider Number

330005

Participating Start Date

4/1/2006

Last Recertification Date

8/15/2024

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

7/6/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/1/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jonathan Thomas Swiatkowski, EVP, Chief Financial Officer
(716) 859-8836

Contract Pharmacy Representative

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

Signed By Date

7/6/2017

340B Drug Pricing Program Database