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GENOA HEALTHCARE LLC
FQHCLA433E Cascadia Health
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Covered Entity Details
Entity Name
Cascadia Health
Subdivision Name
Cascadia Plaza Health Center 200
Type
Health Center Program Look-Alike
340B ID
FQHCLA433E
Entity Address
4212 SE Division Street STE 200
Portland, OR 97206-1600
Grant Number
LALCS40208
Participating Start Date
1/1/2023
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
3036 NE MARTIN LUTHER KING JR BLVD
STE 136
PORTLAND, OR 97212
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
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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