Contract Pharmacy Details

GENOA HEALTHCARE, LLC
CH093030 ADELANTE HEALTHCARE, INC.

Covered Entity Details

Entity Name

ADELANTE HEALTHCARE, INC.

Subdivision Name

Adelante Healthcare

Type

HRSA-Funded Health Center

340B ID

CH093030

Entity Address

3033 N. Central Ave.
Phoenix, AZ 85012-4403

Grant Number

H80CS00140

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE, LLC

Pharmacy Address

1705 W MAIN ST
MESA, AZ 85201-6920

Pharmacy Comments

Contract Details

Approval Date

7/7/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/17/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard Miller, CFO
(623) 583-3001

Contract Pharmacy Representative

Kayla Richardson, Contracts Administrator
(623) 255-3965

Signed By Date

7/7/2015

340B Drug Pricing Program Database