Contract Pharmacy Details

AVELLA OF DEER VALLEY
CH032960 WESTSIDE FAMILY HEALTHCARE, INC.

Covered Entity Details

Entity Name

WESTSIDE FAMILY HEALTHCARE, INC.

Subdivision Name

Westside Family Healthcare - Administration Office

Type

HRSA-Funded Health Center

340B ID

CH032960

Entity Address

300 Water Street
Suite 200
Wilmington, DE 19801-5043

Grant Number

H80CS00789

Participating Start Date

4/1/2000

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

AVELLA OF DEER VALLEY

Pharmacy Address

23620 N 20TH DR #12
PHOENIX, AZ 85085-0621

Pharmacy Comments

Contract Details

Approval Date

10/8/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

LOLITA A. LOPEZ, PRESIDENT AND CEO
(302) 656-8292

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677

Signed By Date

10/8/2015

340B Drug Pricing Program Database