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AVELLA OF DEER VALLEY
CH045260 PALMETTO HEALTH COUNCIL, INC
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Covered Entity Details
Entity Name
PALMETTO HEALTH COUNCIL, INC
Subdivision Name
YourTown Health
Type
HRSA-Funded Health Center
340B ID
CH045260
Entity Address
643 Main St
Palmetto, GA 30268-1138
Grant Number
H80CS00460
Participating Start Date
4/1/2008
Last Recertification Date
2/19/2025
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
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jon W. Wollenzien Jr., Chief Executive Officer
(404) 929-8824 Ext: 222
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/16/2018
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