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GENOA HEALTHCARE LLC
CHC26566-00 JANE PAULEY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26566-00
Entity Address
8931 E. 30th Street
Indianapolis, IN 46219-1501
Grant Number
H80CS26566
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
5470 E 16TH STREET SUITE 150
INDIANAPOLIS, IN 46218
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
Aaron Knapp, Dir of Pharmacy Operations
(812) 632-0917
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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