Contract Pharmacy Details

GENOA HEALTHCARE LLC
RWI900152B AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - San Diego

Type

Ryan White Part A

340B ID

RWI900152B

Entity Address

3580 5th Avenue
San Diego, CA 92103-5017

Grant Number

H89HA00001

Participating Start Date

4/1/2017

Last Recertification Date

2/18/2025

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

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

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