Contract Pharmacy Details

GENOA HEALTHCARE LLC
RWII235101 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Fort Tar

Type

Ryan White Part B

340B ID

RWII235101

Entity Address

1001 Monticello Ave
Suite 100
Norfolk, VA 23510

Grant Number

X07HA00009

Participating Start Date

7/1/2019

Last Recertification Date

2/26/2023

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

2120 WASHINGTON BLVD RM 115
ARLINGTON, VA 22204

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

7/1/2023
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