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AVELLA OF SACRAMENTO, INC.
FQHCLA225 Maricopa County Special Health Care District
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Covered Entity Details
Entity Name
Maricopa County Special Health Care District
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA225
Entity Address
2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008
Grant Number
LALCS00037
Participating Start Date
10/1/2007
Last Recertification Date
2/15/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
AVELLA OF SACRAMENTO, INC.
Pharmacy Address
2288 AUBURN BLVD #102
SACRAMENTO, CA 95821
Pharmacy Comments
01/28/2013 name update (was GREATER SACRAMENTO PHARMACY, INC.)
Contract Details
Approval Date
1/14/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(602) 344-1258
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/14/2018
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