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GENOA HEALTHCARE LLC
FQHCLA433B Cascadia Health
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Covered Entity Details
Entity Name
Cascadia Health
Subdivision Name
Cascadia Behavioral Healthcare- Administrative Office
Type
Health Center Program Look-Alike
340B ID
FQHCLA433B
Entity Address
847 NE 19th Ave STE 100
Portland, OR 97232-2684
Grant Number
LALCS40208
Participating Start Date
3/7/2022
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
3036 NE MARTIN LUTHER KING JR BLVD
STE 136
PORTLAND, OR 97212
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Derald Walker, President/CEO
(503) 238-0769
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2022
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