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GENOA HEALTHCARE LLC
RWII32501A AIDS HEALTHCARE FOUNDATION
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Covered Entity Details
Entity Name
AIDS HEALTHCARE FOUNDATION
Subdivision Name
AHF HEALTHCARE CENTER PENSACOLA /MOBILE TREATMENT/TESTING VAN
Type
Ryan White Part B
340B ID
RWII32501A
Entity Address
4300 BAYOU BLVD
SUITE 17D
Pensacola, FL 32503
Grant Number
X07HA00057
Participating Start Date
7/1/2010
Last Recertification Date
2/16/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1700 EDUCATION AVE
BUILDING A, STE P
PUNTA GORDA, FL 33950
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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