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GENOA HEALTHCARE LLC
CH031000 TUG RIVER HEALTH ASSOCIATION, INC
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Covered Entity Details
Entity Name
TUG RIVER HEALTH ASSOCIATION, INC
Subdivision Name
TUG RIVER HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH031000
Entity Address
5883 Black Diamond Highway
GARY, WV 24836-0507
Grant Number
H80CS00701
Participating Start Date
10/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
200 12TH STREET EXTENSION
PRINCETON, WV 24740
Pharmacy Comments
Contract Details
Approval Date
8/25/2021
Contract Begin Date
8/31/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Crofton, CEO
(304) 448-2101
Contract Pharmacy Representative
Genoa Healthcare
Jerrie Rice, Pharmacy
(763) 340-7887
Signed By Date
8/25/2021
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