340B Drug Pricing Program Database
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GENOA HEALTHCARE LLC
RRC230216-00 MCLAREN PORT HURON
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Covered Entity Details
Entity Name
MCLAREN PORT HURON
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230216-00
Entity Address
1221 PINE GROVE AVENUE
PORT HURON, MI 48060
Medicare Provider Number
230216
Participating Start Date
12/7/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
3111 ELECTRIC AVENUE
PORT HURON, MI 48060
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/12/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sharelle Brown, Corporate, 340B Program Director
(248) 396-8085
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/16/2023
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