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GENOA HEALTHCARE LLC
CH041700 COLLIER HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COLLIER HEALTH SERVICES, INC.
Subdivision Name
COLLIER HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH041700
Entity Address
1454 Madison Ave W
Immokalee, FL 34142-2200
Grant Number
H80CS00735
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
6075 BATHEY LANE, SUITE D-5
NAPLES, FL 34116
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mike Ellis, President/CEO
(239) 658-3158
Contract Pharmacy Representative
Kenneth S. Barr, Deputy Chief Compliance Officer - Chief Privacy Officer
(301) 892-1580
Signed By Date
7/18/2017
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