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GENOA HEALTHCARE LLC
STD85012 Spectrum Medical Care Center
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Covered Entity Details
Entity Name
Spectrum Medical Care Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85012
Entity Address
52 E Monterey Way
Suite A
Phoenix, AZ 85012
Grant Number
1 NU62PS924550-01-00
Participating Start Date
1/1/2019
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1101 NORTH CENTRAL AVE
STE 102
PHOENIX, AZ 85004
Pharmacy Comments
Contract Details
Approval Date
12/14/2021
Contract Begin Date
12/15/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thanes J Vanig, Chief Medical Officer
(602) 604-9500
Contract Pharmacy Representative
Optum
Dave Miller, Account Manager
(847) 917-1731
Signed By Date
12/14/2021
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