Contract Pharmacy Details

GENOA HEALTHCARE LLC
RWII761111 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER FORT WORTH

Type

Ryan White Part B

340B ID

RWII761111

Entity Address

400 N. BEACH STREET SUITE 104
FORT WORTH, TX 76111

Grant Number

X07HA00054

Participating Start Date

1/1/2016

Last Recertification Date

2/26/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

2400 TRAWOOD DRIVE
SUITE 303A
EL PASO, TX 79936

Pharmacy Comments

Contract Details

Approval Date

7/9/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

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

7/9/2021

340B Drug Pricing Program Database