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GENOA HEALTHCARE LLC
STD16508 Central Outreach Wellness Center, LLC
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Covered Entity Details
Entity Name
Central Outreach Wellness Center, LLC
Subdivision Name
Central Outreach Wellness Center, LLC Erie
Type
Sexually Transmitted Diseases
340B ID
STD16508
Entity Address
3104 State Street
Erie, PA 16508
Grant Number
NH25PS005144
Participating Start Date
1/1/2021
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
3609 N BROAD ST STE P
PHILADELPHIA, PA 19140
Pharmacy Comments
Contract Details
Approval Date
10/29/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/29/2021
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