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GENOA HEALTHCARE LLC
TB850155 ARIZONA DEPARTMENT OF HEALTH SERVICES
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Covered Entity Details
Entity Name
ARIZONA DEPARTMENT OF HEALTH SERVICES
Subdivision Name
BUREAU OF INFECTIOUS DISEASE SERVICES
Type
Tuberculosis
340B ID
TB850155
Entity Address
150 N. 18TH AVENUE
Suite 300
PHOENIX, AZ 85007
Grant Number
NU52PS910271
Participating Start Date
10/1/2022
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1101 NORTH CENTRAL AVE
STE 102
PHOENIX, AZ 85004
Pharmacy Comments
Contract Details
Approval Date
8/4/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Quentin Mazzaferro, TB Control Program Manager
(602) 647-3802
Contract Pharmacy Representative
Genoa Healthcare
Kate Anthony, Purchasing Specialist
(412) 935-4271
Signed By Date
7/13/2022
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