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GENOA HEALTHCARE LLC
DSH220011 CAMBRIDGE PUBLIC HEALTH COMMISSION
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Covered Entity Details
Entity Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220011
Entity Address
1493 Cambridge Street
CAMBRIDGE, MA 02139
Medicare Provider Number
220011
Participating Start Date
7/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
417 LIBERTY ST STE 1B
SPRINGFIELD, MA 01104
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/15/2024
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