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GENOA HEALTHCARE LLC
FQHCLA354E ASPIRE INDIANA HEALTH INC
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Covered Entity Details
Entity Name
ASPIRE INDIANA HEALTH INC
Subdivision Name
Aspire Indiana Health - Willowbrook
Type
Health Center Program Look-Alike
340B ID
FQHCLA354E
Entity Address
2506 Willowbrook Pkwy
Indianapolis, IN 46205-1564
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
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Gregory Sheward, Vice President, Strategy & Business Development
(317) 587-0537
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2023
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