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GENOA HEALTHCARE LLC
CHC29001-03 Wheeler Clinic, Inc.
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Covered Entity Details
Entity Name
Wheeler Clinic, Inc.
Subdivision Name
Bristol Health & Wellness Behavioral Health Center
Type
HRSA-Funded Health Center
340B ID
CHC29001-03
Entity Address
225 N Main St
Bristol, CT 06010-4926
Grant Number
H80CS29001
Participating Start Date
4/1/2019
Last Recertification Date
2/9/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
40 HART ST STE P
NEW BRITAIN, CT 06052
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Athena Marie Dellas, Chief Financial Officer
(860) 793-4235
Contract Pharmacy Representative
Genoa Healthcare
Iman Badawy, Director of Operations
(845) 521-1196
Signed By Date
7/15/2021
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