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AVELLA OF TUCSON
DSH320001 UNIVERSITY OF NEW MEXICO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF NEW MEXICO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320001
Entity Address
2211 Lomas Blvd NE
ALBUQUERQUE, NM 87106
Medicare Provider Number
320001
Participating Start Date
9/1/1993
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
AVELLA OF TUCSON
Pharmacy Address
4512 E CAMP LOWELL DR
TUCSON, AZ 85712-1282
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Ella B. Watt, CFO
(505) 272-1840
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/15/2015
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