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GENOA HEALTHCARE LLC
FQHCLA262 UNIVERSAL MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
UNIVERSAL MEDICAL SERVICES, INC.
Subdivision Name
AXIS MEDICAL CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA262
Entity Address
1801 NICOLLET AVENUE
FLOOR 1
MINNEAPOLIS, MN 55403
Grant Number
LALCS00028
Participating Start Date
7/1/2010
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
Theodore James, CEO
(612) 823-2947 Ext: 826
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/14/2024
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