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GENOA HEALTHCARE LLC
FQHCLA354 ASPIRE INDIANA HEALTH INC
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Covered Entity Details
Entity Name
ASPIRE INDIANA HEALTH INC
Subdivision Name
Aspire Indiana Health - Carmel
Type
Health Center Program Look-Alike
340B ID
FQHCLA354
Entity Address
697 Pro-Med Ln
Carmel, IN 46032-5323
Grant Number
LALCS31260
Participating Start Date
1/1/2018
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
2506 WILLOWBROOK PKWY RM 1300
INDIANAPOLIS, IN 46205
Pharmacy Comments
Contract Details
Approval Date
11/14/2022
Contract Begin Date
11/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerry Landers, VP, Strategy & Business Development
(317) 587-0508
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
11/14/2022
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