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AVELLA OF SACRAMENTO, INC.
DSH050231 POMONA VALLEY HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050231
Entity Address
1798 NORTH GAREY AVENUE
POMONA, CA 91767
Medicare Provider Number
050231
Participating Start Date
1/1/2007
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
AVELLA OF SACRAMENTO, INC.
Pharmacy Address
2288 AUBURN BLVD #102
SACRAMENTO, CA 95821
Pharmacy Comments
01/28/2013 name update (was GREATER SACRAMENTO PHARMACY, INC.)
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
RICHARD YOCHUM, CEO
(909) 865-9500 Ext: 9975
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/14/2016
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