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GENOA HEALTHCARE LLC
CH05006Z Community Health Partnership of Illinois
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Covered Entity Details
Entity Name
Community Health Partnership of Illinois
Subdivision Name
Mobile Medical & Dental Van
Type
HRSA-Funded Health Center
340B ID
CH05006Z
Entity Address
1009 Main St
Mendota, IL 61342-1604
Grant Number
H80CS00748
Participating Start Date
1/1/2023
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
5342 W ELM STREET, STE P
MCHENRY, IL 60050-4029
Pharmacy Comments
Contract Details
Approval Date
4/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eleace Erica Sawyers, Chief Executive Officer
(786) 299-1724
Contract Pharmacy Representative
Genoa
Renee Pogorzelski, Director of Operations
(847) 710-9019
Signed By Date
4/5/2024
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