Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
DSH450034 CHRISTUS HOSPITAL

Covered Entity Details

Entity Name

CHRISTUS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450034

Entity Address

2830 CALDER STREET
BEAUMONT, TX 77702-1048

Medicare Provider Number

450034

Participating Start Date

5/25/2021

Last Recertification Date

8/23/2024

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

7/18/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102

Contract Pharmacy Representative

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

Signed By Date

7/18/2016

340B Drug Pricing Program Database