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GENOA HEALTHCARE LLC
CHC28956-07 Valle Del Sol, Inc.
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Covered Entity Details
Entity Name
Valle Del Sol, Inc.
Subdivision Name
Valle del Sol_4135
Type
HRSA-Funded Health Center
340B ID
CHC28956-07
Entity Address
4135 S Power Rd
Ste 108
Mesa, AZ 85212
Grant Number
H80CS28956
Participating Start Date
1/1/2022
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
3807 N 7TH ST STE P
PHOENIX, AZ 85014
Pharmacy Comments
Contract Details
Approval Date
11/10/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carmen Heredia, Chief Executive Officer
(602) 258-6797 Ext: 1320
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
11/10/2021
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