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AVELLA OF DEER VALLEY, INC. #38
CH041279N RURAL HEALTH SERVICES CONSORTIUM, INC.
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES CONSORTIUM, INC.
Subdivision Name
Rogersville Medical Complex
Type
HRSA-Funded Health Center
340B ID
CH041279N
Entity Address
4307 Hwy 66S
Rogersville, TN 37857-6028
Grant Number
H80CS00421
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
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
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
Rural Health Services Consortium, Inc.
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Signed By Date
10/12/2017
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