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GENOA HEALTHCARE LLC
CH05696B SOUTHSIDE COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
SOUTHSIDE COMMUNITY HEALTH SERVICES
Subdivision Name
Southside Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH05696B
Entity Address
324 E 35TH STREET
MINNEAPOLIS, MN 55408
Grant Number
H80CS00198
Participating Start Date
1/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1900 SILVER LAKE ROAD
STE 111
NEW BRIGHTON, MN 55112
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Cazaban, Executive Director
(612) 821-2025
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/14/2024
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