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AVELLA OF DEER VALLEY, INC. #38
CH022070 ANTHONY L JORDAN HEALTH CORP
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Covered Entity Details
Entity Name
ANTHONY L JORDAN HEALTH CORP
Subdivision Name
Main Site
Type
HRSA-Funded Health Center
340B ID
CH022070
Entity Address
82 Holland St
Rochester, NY 14605-2131
Grant Number
H80CS21582
Participating Start Date
10/1/2011
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVELLA OF DEER VALLEY, INC. #38
Pharmacy Address
24416 N. 19TH AVE
PHOENIX, AZ 85085-1887
Pharmacy Comments
Contract Details
Approval Date
7/25/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jonathan Clune, CFO
(585) 423-2813
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/25/2018
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