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GENOA HEALTHCARE LLC
FQHCLA430A MENTAL HEALTH CARE, INC.
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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
GENOA HEALTHCARE LLC
Pharmacy Address
5707 N 22ND ST
TAMPA, FL 33610
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
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
7/15/2022
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