Contract Pharmacy Details

GENOA HEALTHCARE LLC
FQHCLA419A Centerstone Health Services, Inc.

Covered Entity Details

Entity Name

Centerstone Health Services, Inc.

Subdivision Name

Centerstone Health Services

Type

Health Center Program Look-Alike

340B ID

FQHCLA419A

Entity Address

645 S Rogers St
Bloomington, IN 47403-2353

Grant Number

LALCS40181

Participating Start Date

4/1/2021

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

720 NORTH MARR ROAD
COLUMBUS, IN 47201-6660

Pharmacy Comments

Contract Details

Approval Date

4/8/2021

Contract Begin Date

4/15/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Robert Siegmann, Executive Director
(812) 344-4935

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/8/2021

340B Drug Pricing Program Database