Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
CAH181328-00 ARH Mary Breckinridge Health Services, Inc.

Covered Entity Details

Entity Name

ARH Mary Breckinridge Health Services, Inc.

Subdivision Name

Barbourville ARH Hospital

Type

Critical Access Hospital

340B ID

CAH181328-00

Entity Address

80 HOSPITAL DRIVE
BARBOURVILLE, KY 40906

Medicare Provider Number

181328

Participating Start Date

1/1/2016

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
Ownership change

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

340B Drug Pricing Program Database