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AVELLA OF DEER VALLEY, INC. #38
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)
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Covered Entity Details
Entity Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510022
Entity Address
501 MORRIS STREET
CHARLESTON, WV 25301
Medicare Provider Number
510022
Participating Start Date
9/22/2005
Last Recertification Date
8/22/2024
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
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
STEPHEN BELL, VICE PRESIDENT - FINANCE
(304) 388-6251
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/9/2018
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