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AVELLA OF COLUMBUS
DSH330005 KALEIDA HEALTH
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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 COLUMBUS
Pharmacy Address
4830 KNIGHTSBRIDGE BLVD STE C
COLUMBUS, OH 43214-2300
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
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