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AVELLA OF DEER VALLEY
CH0452880 TRIAD HEALTH SYSTEM INC
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Covered Entity Details
Entity Name
TRIAD HEALTH SYSTEM INC
Subdivision Name
TRIAD HEALTH SYSTEMS CHC
Type
HRSA-Funded Health Center
340B ID
CH0452880
Entity Address
441 US Highway 42 West
Warsaw, KY 41095-9323
Grant Number
H80CS08785
Participating Start Date
7/1/2008
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
AVELLA OF DEER VALLEY
Pharmacy Address
23620 N 20TH DR #12
PHOENIX, AZ 85085-0621
Pharmacy Comments
Contract Details
Approval Date
1/13/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ADAM CRAFT, EXECUTIVE DIRECTOR
(859) 567-1271
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/13/2016
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