340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HOLIDAY CVS, L.L.C.
FQHCLA430A MENTAL HEALTH CARE, INC.
Print
Covered Entity Details
Entity Name
MENTAL HEALTH CARE, INC.
Subdivision Name
Gracepoint Wellness Clinic- North Tampa
Type
Health Center Program Look-Alike
340B ID
FQHCLA430A
Entity Address
13601 Bruce B Downs Blvd Ste 131
Tampa, FL 33613-4610
Grant Number
LALCS40297
Participating Start Date
2/24/2022
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03257
704 W MARTIN LUTHER KING JR BLVD
SEFFNER, FL 33584
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Roaya Tyson, CEO
(813) 965-2630
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session