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GENOA HEALTHCARE LLC
SCH140015-00 BLESSING HOSPITAL
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Covered Entity Details
Entity Name
BLESSING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140015-00
Entity Address
1005 BROADWAY
QUINCY, IL 62301
Medicare Provider Number
140015
Participating Start Date
3/16/2021
Last Recertification Date
8/13/2024
Entity Termination Date
4/1/2025
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
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/1/2024
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