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GENOA HEALTHCARE LLC
DSH050454 UCSF-MEDICAL CENTER
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Covered Entity Details
Entity Name
UCSF-MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050454
Entity Address
505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143
Medicare Provider Number
050454
Participating Start Date
7/1/1993
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
11721 E TELEGRAPH RD UNIT I
SANTA FE SPRINGS, CA 90670
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Bennan, COO Community Hospital Division
(415) 503-8667
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2021
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