Contract Pharmacy Details

GENOA HEALTHCARE LLC
STD15301 Central Outreach Wellness Center, LLC

Covered Entity Details

Entity Name

Central Outreach Wellness Center, LLC

Subdivision Name

Central Outreach Wellness Center, LLC South Office

Type

Sexually Transmitted Diseases

340B ID

STD15301

Entity Address

817 Jefferson Avenue
Washington, PA 15301

Grant Number

NH25PS005144

Participating Start Date

4/1/2018

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

340B Drug Pricing Program Database