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AVELLA OF DEER VALLEY
CH090850 AMPLA HEALTH
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Covered Entity Details
Entity Name
AMPLA HEALTH
Subdivision Name
Ampla Health Lindhurst Medical, Dental, & Xpress Care
Type
HRSA-Funded Health Center
340B ID
CH090850
Entity Address
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Grant Number
H80CS00765
Participating Start Date
1/1/1998
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVELLA OF DEER VALLEY
Pharmacy Address
23620 N 20TH DR #12
PHOENIX, AZ 85085-0621
Pharmacy Comments
Contract Details
Approval Date
12/5/2017
Contract Begin Date
12/6/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Benjamin H. Flores, President & CEO
(530) 674-4261 Ext: 1155
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
12/5/2017
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