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GENOA HEALTHCARE LLC
CHC24145-00 WALLACE MEDICAL CONCERN, THE
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Covered Entity Details
Entity Name
WALLACE MEDICAL CONCERN, THE
Subdivision Name
Wallace Rockwood Clinic
Type
HRSA-Funded Health Center
340B ID
CHC24145-00
Entity Address
18633 SE Stark St.
Suite 401
Portland, OR 97233-5468
Grant Number
H80CS24145
Participating Start Date
4/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
18613 SE STARK ST STE P
PORTLAND, OR 97233
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
1/1/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Lisa Cline, Chief Executive Officer
(503) 907-0591
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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