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AVELLA OF DEER VALLEY, INC. #38
CHC00836-11 South Central Primary Care Center, Inc.
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Covered Entity Details
Entity Name
South Central Primary Care Center, Inc.
Subdivision Name
South Central Primary Care Center - Administrative Building
Type
HRSA-Funded Health Center
340B ID
CHC00836-11
Entity Address
204 E. 4th St.
Ocilla, GA 31774-1539
Grant Number
H80CS00836
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
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
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
10/12/2018
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