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AVELLA OF DEER VALLEY, INC. #38
CHC28363-00 SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
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Covered Entity Details
Entity Name
SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
Subdivision Name
Longview Care Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28363-00
Entity Address
409 N. 6th Street
LONGVIEW, TX 75601-6511
Grant Number
H80CS28363
Participating Start Date
7/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
AVELLA OF DEER VALLEY, INC. #38
Pharmacy Address
DBA AVELLA SPECIALTY PHARMACY
24416 N. 19TH AVE
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Nesvig, CEO
(903) 212-7811 Ext: 7811
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/17/2017
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