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GENOA HEALTHCARE LLC
DSH030013 YUMA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030013
Entity Address
2400 S Avenue A
Yuma, AZ 85364
Medicare Provider Number
030013
Participating Start Date
1/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
2545 S ARIZONA AVE BLDG B
YUMA, AZ 85364
Pharmacy Comments
Contract Details
Approval Date
1/12/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Willie, CFO
(928) 336-7015
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/12/2022
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