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GENOA HEALTHCARE LLC
FQHCLA433D Cascadia Health
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Covered Entity Details
Entity Name
Cascadia Health
Subdivision Name
Cascadia Clackamas Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA433D
Entity Address
17070 SE Mcloughlin Blvd
Milwaukie, OR 97267-4960
Grant Number
LALCS40208
Participating Start Date
1/1/2023
Last Recertification Date
1/30/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
18417 SE OAK STREET
PORTLAND, OR 97233
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Derald Walker, President/CEO
(503) 238-0769
Contract Pharmacy Representative
Optum Rx 340B
Eric Howard, National Account Manager
(503) 601-9663
Signed By Date
1/13/2023
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