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AVELLA OF DEER VALLEY
CH0412790 RURAL HEALTH SERVICES CONSORTIUM
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES CONSORTIUM
Subdivision Name
HAWKINS MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH0412790
Entity Address
4966 HIGHWAY 11 WEST
ROGERSVILLE, TN 37857
Grant Number
H80CS00421
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
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
1/5/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/24/2024
Ownership change
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/5/2016
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