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GENOA HEALTHCARE LLC
CH0510280 LAKE SUPERIOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Subdivision Name
LAKE SUPERIOR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0510280
Entity Address
4325 Grand Ave
Duluth, MN 55807-2730
Grant Number
H80CS00811
Participating Start Date
10/1/2000
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
332 W SUPERIOR, STE 300
DULUTH, MN 55802
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
Lee Homan, CEO
(218) 336-3503
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/14/2024
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