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GENOA HEALTHCARE LLC
CHC26567-09 MERIDIAN SERVICES CORP
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Covered Entity Details
Entity Name
MERIDIAN SERVICES CORP
Subdivision Name
Meridian Health Services Richmond
Type
HRSA-Funded Health Center
340B ID
CHC26567-09
Entity Address
16 SW 5TH ST
RICHMOND, IN 47374-4101
Grant Number
H80CS26567
Participating Start Date
4/1/2016
Last Recertification Date
2/9/2018
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
130 N. TILLOTSON AVENUE
MUNCIE, IN 47304-3987
Pharmacy Comments
Contract Details
Approval Date
4/7/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amelia Clark, VP Community Health
(765) 254-5102
Contract Pharmacy Representative
Genoa, A QoL Healthcare Company, LLC
Bruce Hinshaw, Director of Operations, Reg 3
(765) 891-0394
Signed By Date
4/7/2016
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