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AVELLA OF DEER VALLEY, INC. #38
CH052900 COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
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Covered Entity Details
Entity Name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Subdivision Name
N/A
Type
HRSA-Funded Health Center
340B ID
CH052900
Entity Address
941 MARKET STREET
PIKETON, OH 45661
Grant Number
H80CS00399
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
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
1/3/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2021
Ownership change
Contacts
Covered Entity Signing Official
Keith Pitts, President and Chief Executive Officer
(216) 770-3409 Ext: 7009
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/3/2017
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