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GENOA HEALTHCARE LLC
CHC25680-15 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at 295 Park Avenue
Type
HRSA-Funded Health Center
340B ID
CHC25680-15
Entity Address
295 Park Ave
Portland, ME 04102-2911
Grant Number
H80CS25680
Participating Start Date
4/1/2023
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
62 ELM STREET, SUITE 23, ROOM P
PORTLAND, ME 04101
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2023
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