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PROCARE PHARMACY, 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
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
10/5/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
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
10/5/2022
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