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GENOA HEALTHCARE LLC
CH06723S Hidalgo Medical Services
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Covered Entity Details
Entity Name
Hidalgo Medical Services
Subdivision Name
HMS Tu Casa
Type
HRSA-Funded Health Center
340B ID
CH06723S
Entity Address
3200 32nd Street Bypass
Silver City, NM 88061
Grant Number
H80CS00744
Participating Start Date
4/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1007 NORTH POPE STREET, SUITE P
SILVER CITY, NM 88061
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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