Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
CH068160 HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Waco Family Medicine - Central

Type

HRSA-Funded Health Center

340B ID

CH068160

Entity Address

1600 PROVIDENCE DR
WACO, TX 76707-2261

Grant Number

H80CS00719

Participating Start Date

1/1/2000

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

10/10/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/22/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ROLAND A. GOERTZ, CEO
(254) 313-4201

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677

Signed By Date

10/10/2017

340B Drug Pricing Program Database