Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
RWI891041A John Phoenix APRN, PLLC

Covered Entity Details

Entity Name

John Phoenix APRN, PLLC

Subdivision Name

Type

Ryan White Part A

340B ID

RWI891041A

Entity Address

The Gay and Lesbian Center of Southern Nevada
401 S. Maryland Parkway
Las Vegas, NV 89101

Grant Number

H89HA06900

Participating Start Date

4/1/2020

Last Recertification Date

Entity Termination Date

4/1/2021

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

2/20/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John Phoenix, Chief Clinical Officer
(702) 979-1111

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

1/6/2020

340B Drug Pricing Program Database