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GENOA HEALTHCARE LLC
CH06723B HIDALGO MEDICAL SERVICES
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES
Subdivision Name
HMS Mimbres Community Clinic
Type
HRSA-Funded Health Center
340B ID
CH06723B
Entity Address
2672 Hwy 35
San Lorenzo, NM 88041
Grant Number
H80CS00744
Participating Start Date
1/1/2007
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
10/19/2020
Contract Begin Date
1/1/2021
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
10/19/2020
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