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AVELLA OF ORLANDO
DSH010092 DCH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
DCH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010092
Entity Address
809 UNIVERSITY BOULEVARD EAST
TUSCALOOSA, AL 35401
Medicare Provider Number
010092
Participating Start Date
1/1/2004
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
AVELLA OF ORLANDO
Pharmacy Address
100 TECHNOLOGY PARK STE 155
LAKE MARY, FL 32746-6205
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
NINA DUSANG, CFO
(205) 759-7738
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/14/2015
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