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GENOA HEALTHCARE LLC
CH02151BG Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
LISH at Port Jefferson Station
Type
HRSA-Funded Health Center
340B ID
CH02151BG
Entity Address
51 Terryville Rd
Port Jefferson Station, NY 11776
Grant Number
H80CS00313
Participating Start Date
1/1/2017
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1448 5TH AVE STE P1
BAY SHORE, NY 11706
Pharmacy Comments
Contract Details
Approval Date
4/7/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allison Dubois, COO
(914) 734-8600 Ext: 78503
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/7/2025
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