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AVELLA OF DEER VALLEY
CAH191312-00 CHRISTUS Health Central Louisiana DBA CHRISTUS Coushatta Health Care Center
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Covered Entity Details
Entity Name
CHRISTUS Health Central Louisiana DBA CHRISTUS Coushatta Health Care Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191312-00
Entity Address
1635 Marvel Street
Coushatta, LA 71019
Medicare Provider Number
191312
Participating Start Date
1/1/2012
Last Recertification Date
8/16/2024
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
1/23/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nancy Hellyer, CEO
(318) 561-7173
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/23/2016
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