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AVELLA OF DEER VALLEY
CAH141320-00 HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)
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Covered Entity Details
Entity Name
HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141320-00
Entity Address
721 EAST COURT STREET
PARIS, IL 61944
Medicare Provider Number
141320
Participating Start Date
4/1/2011
Last Recertification Date
8/22/2024
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
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RANDY SIMMONS, CEO
(217) 465-4141 Ext: 218
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
10/14/2015
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