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GENOA HEALTHCARE, LLC
CH051278U Tapestry 360 Health
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Covered Entity Details
Entity Name
Tapestry 360 Health
Subdivision Name
Tapestry 360 Health-Thresholds
Type
HRSA-Funded Health Center
340B ID
CH051278U
Entity Address
4423 N Ravenswood Ave
Chicago, IL 60640
Grant Number
H80CS00215
Participating Start Date
7/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE, LLC
Pharmacy Address
4423 N. RAVENSWOOD AVE. STE P100
CHICAGO, IL 60640-5802
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gwenn Rausch, CEO
(773) 296-7587
Contract Pharmacy Representative
Camelia Ciurbe, Site Manager
(773) 313-3075
Signed By Date
7/5/2017
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