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GENOA HEALTHCARE LLC
STD159011 Johnstown Free Medical Cllinic DBA Highlands Health: Laurel Highlands Free & Charitable Medical Clinic
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Covered Entity Details
Entity Name
Johnstown Free Medical Cllinic DBA Highlands Health: Laurel Highlands Free & Charitable Medical Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD159011
Entity Address
315 Locust Street, 2nd Floor
Johnstown, PA 15901
Johnstown, PA 15901
Grant Number
NH25PS004354
Participating Start Date
10/1/2017
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
119 WALNUT STREET
SUITE 500
JOHNSTOWN, PA 15901
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rosalie Danchanko, Executive Director
(814) 534-6242
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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