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AVELLA OF DEER VALLEY, INC. #38
CH0518280 Stacy McKay Health & Education Center
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Covered Entity Details
Entity Name
Stacy McKay Health & Education Center
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0518280
Entity Address
6450 US HWY 6
PORTAGE, IN 46368
Grant Number
H80CS02458
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JANICE WILSON, CEO
(219) 764-6052
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
10/16/2017
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