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GENOA HEALTHCARE LLC
CH0627970 AMISTAD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AMISTAD COMMUNITY HEALTH CENTER
Subdivision Name
AMISTAD COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0627970
Entity Address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Grant Number
H80CS08778
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
850 HARRISON STREET, ROOM 230
WARSAW, IN 46580-3163
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diane Herrero, CFO
(361) 886-3066
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/10/2022
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