Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
DSH340002 MISSION HOSPITALS, INC.

Covered Entity Details

Entity Name

MISSION HOSPITALS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340002

Entity Address

509 BILTMORE AVENUE
ASHEVILLE, NC 28801

Medicare Provider Number

340002

Participating Start Date

7/1/2004

Last Recertification Date

8/29/2018

Entity Termination Date

4/1/2019

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

12/4/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Paul L McDowell, CFO
(828) 213-0184

Contract Pharmacy Representative

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

Signed By Date

12/4/2017

340B Drug Pricing Program Database