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GENOA HEALTHCARE LLC
CHC24136-00 UNITED FAMILY PRACTICE HEALTH CENTER
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Covered Entity Details
Entity Name
UNITED FAMILY PRACTICE HEALTH CENTER
Subdivision Name
United Family Medicine
Type
HRSA-Funded Health Center
340B ID
CHC24136-00
Entity Address
1026 7th St W
Saint Paul, MN 55102-3828
Grant Number
H80CS24136
Participating Start Date
4/1/2013
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
122 WABASHA ST S STE 110
SAINT PAUL, MN 55107
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
Lori A Zook, CFO
(651) 206-7294
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/11/2024
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