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AVELLA OF SCOTTSDALE
DSH030014 HONORHEALTH JOHN C. LINCOLN MED CTR
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Covered Entity Details
Entity Name
HONORHEALTH JOHN C. LINCOLN MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030014
Entity Address
250 E Dunlap Ave
Phoenix, AZ 85020
Medicare Provider Number
030014
Participating Start Date
7/1/2015
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
AVELLA OF SCOTTSDALE
Pharmacy Address
9777 N 91ST ST #C102
SCOTTSDALE, AZ 85258
Pharmacy Comments
Contract Details
Approval Date
10/5/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Maggi Griffin, CEO
(602) 331-5862
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
10/5/2015
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