Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
DSH140114 SWEDISH COVENANT HEALTH

Covered Entity Details

Entity Name

SWEDISH COVENANT HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140114

Entity Address

5145 N CALIFORNIA
CHICAGO, IL 60625

Medicare Provider Number

140114

Participating Start Date

7/1/2004

Last Recertification Date

8/12/2024

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

4/20/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Patricia King, Vice President Legal Affairs
(773) 989-8811

Contract Pharmacy Representative

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

Signed By Date

4/20/2017

340B Drug Pricing Program Database