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GENOA HEALTHCARE LLC
CH08165AH CLINICA CAMPESINA/FAMILY HEALTH SERVICES
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Covered Entity Details
Entity Name
CLINICA CAMPESINA/FAMILY HEALTH SERVICES
Subdivision Name
Clinica Family Health & Wellness -- Broomfield Clinic
Type
HRSA-Funded Health Center
340B ID
CH08165AH
Entity Address
897 Hwy 287 STE 200
Broomfield, CO 80020
Grant Number
H80CS00690
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
975 NORTH STREET, STE P1
BOULDER, CO 80304
Pharmacy Comments
Contract Details
Approval Date
1/29/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Simon Smith, CEO
(303) 665-3036 Ext: 1003
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/14/2025
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