Contract Pharmacy Details

AVELLA OF DEER VALLEY, INC. #38
CH05166D IRONTON AND LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION

Covered Entity Details

Entity Name

IRONTON AND LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION

Subdivision Name

Ironton Health Care Campus

Type

HRSA-Funded Health Center

340B ID

CH05166D

Entity Address

1408 Campbell Dr
Ironton, OH 45638-2301

Grant Number

H80CS00471

Participating Start Date

4/1/2012

Last Recertification Date

2/12/2025

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

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/15/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kelly Adkins, Chief Financial Officer
(740) 532-3534 Ext: 12004

Contract Pharmacy Representative

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

Signed By Date

4/16/2018

340B Drug Pricing Program Database