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GENOA HEALTHCARE OF ILLINOIS, LLC
CH051278M Tapestry 360 Health
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Covered Entity Details
Entity Name
Tapestry 360 Health
Subdivision Name
Tapestry 360 Health - Trilogy
Type
HRSA-Funded Health Center
340B ID
CH051278M
Entity Address
1400 W Greenleaf Ave
Chicago, IL 60626-2805
Grant Number
H80CS00215
Participating Start Date
7/1/2015
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE OF ILLINOIS, LLC
Pharmacy Address
DBA GENOA HEALTHCARE
1400 W GREENLEAF AVENUE, SUITE 101
CHICAGO, IL 60626-2805
Pharmacy Comments
Contract Details
Approval Date
7/9/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gwenn Rausch, CEO
(773) 296-7587
Contract Pharmacy Representative
Genoa, a QoL Healthcare Company
Larry Hart, RPH
(412) 613-4434
Signed By Date
7/9/2015
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