Contract Pharmacy Details

GENOA HEALTHCARE LLC
HV001230 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Arlington

Type

Ryan White Part C

340B ID

HV001230

Entity Address

601 Matlock Centre Circle
Arlington, TX 76015

Grant Number

H76HA00123

Participating Start Date

10/1/2020

Last Recertification Date

3/10/2025

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

7510 FM 1765 STE P1
TEXAS CITY, TX 77591

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

Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111

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