Contract Pharmacy Details

GENOA HEALTHCARE LLC
FQHC638544 Menominee Indian Tribe of Wisconsin

Entity Name

Menominee Indian Tribe of Wisconsin

Subdivision Name

Menominee Tribal Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638544

Entity Address

W3275 WOLF RIVER ROAD
Keshena, WI 54135

Grant Number

Participating Start Date

1/1/2017

Last Recertification Date

2/5/2024

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

49 KESSEL CT, ROOM 123
MADISON, WI 53711

Pharmacy Comments

Approval Date

1/17/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date

2/28/2024

Termination Reason

Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Jerry Waukau, Tribal Health Administrator
(715) 799-5482

Signed By Date

1/17/2023

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677