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AVELLA OF DEER VALLEY, INC. #38
CH034050 BLUE RIDGE MEDICAL CENTER INC
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Covered Entity Details
Entity Name
BLUE RIDGE MEDICAL CENTER INC
Subdivision Name
BLUE RIDGE MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH034050
Entity Address
4038 Thomas Nelson Hwy
Arrington, VA 22922-2302
Grant Number
H80CS00175
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
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
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/20/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Randolph Pirtle, CEO
(434) 263-4000
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
10/15/2018
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