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GENOA HEALTHCARE LLC
CH105600 Mosaic Community Health
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Covered Entity Details
Entity Name
Mosaic Community Health
Subdivision Name
Madras Health Center
Type
HRSA-Funded Health Center
340B ID
CH105600
Entity Address
500 NE A St Ste 100
Madras, OR 97741
Grant Number
H80CS00270
Participating Start Date
10/1/2003
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1128 NW HARRIMAN ST
SUITE 161
BEND, OR 97703
Pharmacy Comments
Contract Details
Approval Date
7/24/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Albert Noyes, Director of Retail Pharmacy
(541) 447-0707 Ext: 7060
Contract Pharmacy Representative
Genoa Healthcare
Sarah Fenwick, VP Network Contracting
(612) 200-1765
Signed By Date
7/24/2018
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