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AVELLA OF DENVER
DSH060008 SAN LUIS VALLEY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SAN LUIS VALLEY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060008
Entity Address
106 BLANCA AVE
ALAMOSA, CO 81101
Medicare Provider Number
060008
Participating Start Date
10/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
AVELLA OF DENVER
Pharmacy Address
1245 E COLFAX AVE STE 102
DENVER, CO 80218-2216
Pharmacy Comments
Contract Details
Approval Date
4/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Konnie Martin, CEO
(719) 587-1202
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/28/2017
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