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GENOA HEALTHCARE LLC
CHC29005-01 PORTER STARKE SERVICES INC
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Covered Entity Details
Entity Name
PORTER STARKE SERVICES INC
Subdivision Name
Marram Health Center
Type
HRSA-Funded Health Center
340B ID
CHC29005-01
Entity Address
3229 Broadway Ste 115
Gary, IN 46409-1040
Grant Number
H80CS29005
Participating Start Date
7/1/2019
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
3176 LANCER ST RM 102
PORTAGE, IN 46368
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aileen Wehren, VP Systems Administration
(219) 476-4567
Contract Pharmacy Representative
Genoa Healthcare, LLC.
Christy Barr, SVP of National Pharmacy Operations
(412) 865-7943
Signed By Date
1/7/2020
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