Contract Pharmacy Details

GENOA HEALTHCARE LLC
RWI761111 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AIDS HEALTHCARE CENTER - FORT WORTH

Type

Ryan White Part A

340B ID

RWI761111

Entity Address

400 N. BEACH STREET SUITE 104
FORT WORTH, TX 76111

Grant Number

H89HA00047

Participating Start Date

7/1/2014

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

9200 HEMPSTEAD RD STE 150 BLDG D
HOUSTON, TX 77008

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

4/15/2021
Agreement registered in error

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

340B Drug Pricing Program Database