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GENOA HEALTHCARE LLC
CH033080 RAINELLE MEDICAL CENTER
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Covered Entity Details
Entity Name
RAINELLE MEDICAL CENTER
Subdivision Name
RAINELLE MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH033080
Entity Address
176 Medical Center Drive
Rainelle, WV 25962-1013
Grant Number
H80CS18278
Participating Start Date
4/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
804 INDUSTRIAL PARK RD
ROOM 27
MAXWELTON, WV 24957
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KRISTI ATHA-RADER, CEO
(304) 438-6188 Ext: 1006
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2022
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