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GENOA HEALTHCARE LLC
CH01517B SEBASTICOOK FAMILY DOCTORS
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Covered Entity Details
Entity Name
SEBASTICOOK FAMILY DOCTORS
Subdivision Name
Sebasticook Family Doctors
Type
HRSA-Funded Health Center
340B ID
CH01517B
Entity Address
118 MOOSEHEAD TRAIL
STE 5
NEWPORT, ME 04953
Grant Number
H80CS02448
Participating Start Date
7/1/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
841 RIVERSIDE DR STE P
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Winslow, CEO
(207) 368-4213
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/14/2025
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