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HOLIDAY CVS, L.L.C.
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
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
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