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AVELLA OF DEER VALLEY, INC. #38
CAH181316-00 ARH MARY BRECKINRIDGE HEALTH SERVICES, INC. DBA MARY BRECKINRIDGE ARH HOSPITAL
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Covered Entity Details
Entity Name
ARH MARY BRECKINRIDGE HEALTH SERVICES, INC. DBA MARY BRECKINRIDGE ARH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181316-00
Entity Address
130 KATE IRELAND DRIVE
HYDEN, KY 41749
Medicare Provider Number
181316
Participating Start Date
10/1/2011
Last Recertification Date
9/3/2024
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
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/11/2018
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