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GENOA HEALTHCARE LLC
FQHCLA430 MENTAL HEALTH CARE, INC.
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Covered Entity Details
Entity Name
MENTAL HEALTH CARE, INC.
Subdivision Name
Gracepoint Wellness Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA430
Entity Address
5707 N. 22nd Street
Tampa, FL 33610-4350
Grant Number
LALCS40297
Participating Start Date
1/1/2022
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
5707 N 22ND ST
TAMPA, FL 33610
Pharmacy Comments
Contract Details
Approval Date
10/13/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Roaya Tyson, CEO
(813) 965-2630
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2021
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