Contract Pharmacy Details

EXPRESS SCRIPTS
FQHCLA430 MENTAL HEALTH CARE, INC.

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

EXPRESS SCRIPTS

Pharmacy Address

ESI MAIL PHARMACY SERVICE INC
4600 N HANLEY RD
SAINT LOUIS, MO 63134

Pharmacy Comments

Contract Details

Approval Date

1/17/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/31/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Roaya Tyson, CEO
(813) 965-2630

Contract Pharmacy Representative

Express Scripts
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

1/17/2022

340B Drug Pricing Program Database