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GENOA HEALTHCARE LLC
CH056420 LAWNDALE CHRISTIAN HEALTH CENTER
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Covered Entity Details
Entity Name
LAWNDALE CHRISTIAN HEALTH CENTER
Subdivision Name
Lawndale Christian Health Center Main Clinic
Type
HRSA-Funded Health Center
340B ID
CH056420
Entity Address
3860 W Ogden Ave
Chicago, IL 60623-2460
Grant Number
H80CS00725
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
5710 N. BROADWAY STREET, SUITE P
CHICAGO, IL 60660-4302
Pharmacy Comments
Contract Details
Approval Date
4/5/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alyssa Sianghio, Chief Administrative Officer (CAO)
(872) 588-3015
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/5/2022
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