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GENOA HEALTHCARE LLC
CHC25680-14 Portland Community Health Center
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Covered Entity Details
Entity Name
Portland Community Health Center
Subdivision Name
Greater Portland Health at Sagamore Village
Type
HRSA-Funded Health Center
340B ID
CHC25680-14
Entity Address
68 Popham St
Portland, ME 04102-1151
Grant Number
H80CS25680
Participating Start Date
10/1/2021
Last Recertification Date
2/23/2024
Entity Termination Date
10/1/2024
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
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
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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