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GENOA HEALTHCARE LLC
CHC25680-12 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at Westbrook High School
Type
HRSA-Funded Health Center
340B ID
CHC25680-12
Entity Address
125 Stroudwater St
Westbrook, ME 04092-4045
Grant Number
H80CS25680
Participating Start Date
7/1/2021
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
62 ELM STREET, SUITE 23, ROOM P
PORTLAND, ME 04101
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2021
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