340B Drug Pricing Program Database

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

130 N. TILLOTSON AVENUE
MUNCIE, IN 47304-3987

Pharmacy Comments

Approval Date

4/7/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

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