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GENOA HEALTHCARE LLC
CH090090 MARIPOSA COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MARIPOSA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
MARIPOSA COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH090090
Entity Address
1852 N Mastick Way
Nogales, AZ 85621-1063
Grant Number
H80CS00752
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1021 E PALMDALE ST STE 150-P
TUCSON, AZ 85714
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Prevost, CEO
(520) 281-1550 Ext: 1005
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/11/2024
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