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GENOA HEALTHCARE LLC
CH01158A LAMPREY HEALTH CARE
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Covered Entity Details
Entity Name
LAMPREY HEALTH CARE
Subdivision Name
LAMPREY HEALTH CARE - RAYMOND CENTER
Type
HRSA-Funded Health Center
340B ID
CH01158A
Entity Address
128 ROUTE 27
RAYMOND, NH 03077
Grant Number
H80CS00640
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
128 ROUTE 27, SUITE P
RAYMOND, NH 03077
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory White, CEO
(603) 659-2494 Ext: 7214
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/13/2025
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