Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
DSH320002 ST. VINCENT HOSPITAL

Covered Entity Details

Entity Name

ST. VINCENT HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320002

Entity Address

455 ST. MICHAELS DRIVE
SANTA FE, NM 87505

Medicare Provider Number

320002

Participating Start Date

1/1/2014

Last Recertification Date

8/23/2024

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

7/13/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/19/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Patrick B. Carrier, President & CEO
(505) 913-5202

Contract Pharmacy Representative

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

Signed By Date

7/13/2016

340B Drug Pricing Program Database