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GENOA HEALTHCARE LLC
CH057110 THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Third Street Community Clinic, Inc
Type
HRSA-Funded Health Center
340B ID
CH057110
Entity Address
600 W 3rd St
Mansfield, OH 44906-2633
Grant Number
H80CS00581
Participating Start Date
10/1/2001
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
701 BROOKSEDGE PLAZA DR STE C
WESTERVILLE, OH 43081
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/24/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Peggy Anderson, CEO
(419) 526-7880
Contract Pharmacy Representative
Genoa-Dublin
Abby Ward, Contract person
(614) 943-4055
Signed By Date
7/14/2022
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