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GENOA HEALTHCARE LLC
CAH321300-00 SIERRA VISTA HOSPITAL
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Covered Entity Details
Entity Name
SIERRA VISTA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321300-00
Entity Address
800 EAST 9TH AVE.
TRUTH OR CONSEQUENCES, NM 87901-1961
Medicare Provider Number
321300
Participating Start Date
7/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1007 NORTH POPE STREET, SUITE P
SILVER CITY, NM 88061
Pharmacy Comments
Contract Details
Approval Date
5/2/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frank A Corcoran, CEO
(575) 743-1201
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
5/2/2023
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