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AVELLA OF DEER VALLEY
CH0423590 Tandem Health SC
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Covered Entity Details
Entity Name
Tandem Health SC
Subdivision Name
Tandem Health
Type
HRSA-Funded Health Center
340B ID
CH0423590
Entity Address
1278 North Lafayette Drive
Sumter, SC 29150-2964
Grant Number
H80CS00868
Participating Start Date
1/1/2004
Last Recertification Date
2/12/2025
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
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
ANNIE BROWN, CEO
(803) 774-4545
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/15/2016
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