Contract Pharmacy Details

GENOA HEALTHCARE LLC
RWI07834 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Denville

Type

Ryan White Part A

340B ID

RWI07834

Entity Address

295 E Main Street
#315
Denville, NJ 07834

Grant Number

H89HA00003

Participating Start Date

7/1/2019

Last Recertification Date

2/16/2024

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

700 AIRPORT RD
LAKEWOOD, NJ 08701

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

7/1/2024
Covered Entity Terminated

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