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GENOA HEALTHCARE LLC
CH067230 HIDALGO MEDICAL SERVICES, INC
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES, INC
Subdivision Name
HIDALGO MEDICAL SERVICES
Type
HRSA-Funded Health Center
340B ID
CH067230
Entity Address
530 De Moss St
Lordsburg, NM 88045-2618
Grant Number
H80CS00744
Participating Start Date
10/1/2001
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
530 EAST DEMOSS STREET, STE P
LORDSBURG, NM 88045
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Otero, CEO
(575) 590-7090
Contract Pharmacy Representative
Genoa, a QoL Healthcare Company
Larry Hart, RPH
(412) 613-4434
Signed By Date
7/5/2017
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