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GENOA HEALTHCARE LLC
HV01713 MetroHealth
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Covered Entity Details
Entity Name
MetroHealth
Subdivision Name
Type
Ryan White Part C
340B ID
HV01713
Entity Address
1012 14TH STREET, NW
SUITE 700
WASHINGTON, DC 20005
Grant Number
H89HA00012
Participating Start Date
7/1/2009
Last Recertification Date
1/29/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
801 PENNSYLVANIA AVENUE SE
SUITE 120
WASHINGTON, DC 20003-2167
Pharmacy Comments
Contract Details
Approval Date
1/13/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LLOYD H. BUCKNER, EXECUTIVE DIRECTOR
(202) 638-0750
Contract Pharmacy Representative
Jason Kan, Director of Operations
(401) 318-2986
Signed By Date
1/13/2017
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