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AVITA DRUGS OREGON LLC
CH10163J Valley Family Health Care, Inc.
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Covered Entity Details
Entity Name
Valley Family Health Care, Inc.
Subdivision Name
Valley Family Health Care - Payette Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH10163J
Entity Address
1501 NE 10th Ave
Payette, ID 83661-5420
Grant Number
H80CS00556
Participating Start Date
7/1/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS OREGON LLC
Pharmacy Address
DBA: AVITA PHARMACY 1027
2236 SE BELMONT ST STE A
PORTLAND, OR 97214-2817
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Heinze, CEO
(208) 642-7364
Contract Pharmacy Representative
Long's Drugs
Ashley Ellis, Corporate Counsel
(803) 254-5884 Ext: 42309
Signed By Date
4/15/2020
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