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GENOA HEALTHCARE LLC
CH080140 SUNRISE COMMUNITY HEALTH
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Covered Entity Details
Entity Name
SUNRISE COMMUNITY HEALTH
Subdivision Name
MONFORT FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH080140
Entity Address
2930 11th Ave
Evans, CO 80620
Grant Number
H80CS00804
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1300 N 17TH AVE
GREELEY, CO 80631
Pharmacy Comments
Contract Details
Approval Date
3/13/2012
Contract Begin Date
3/13/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mitzi Moran, CEO
(970) 350-4606
Contract Pharmacy Representative
Genoa healthcare, LLC
Larry Hart, Director New Business
(412) 613-4434
Signed By Date
3/5/2012
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