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GENOA HEALTHCARE LLC
FQHCLA419 Centerstone Health Services, Inc.
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Covered Entity Details
Entity Name
Centerstone Health Services, Inc.
Subdivision Name
Centerstone Health Services - Connersville
Type
Health Center Program Look-Alike
340B ID
FQHCLA419
Entity Address
390 Erie Ave
Connersville, IN 47331-3177
Grant Number
LALCS40181
Participating Start Date
4/1/2021
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
65 AIRPORT PKWY STE 109
GREENWOOD, IN 46143
Pharmacy Comments
Contract Details
Approval Date
1/9/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Siegmann, Executive Director
(812) 344-4935
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/9/2024
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