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GENOA HEALTHCARE LLC
STD328091 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Orlando
Type
Sexually Transmitted Diseases
340B ID
STD328091
Entity Address
130 E Marks St
Orlando, FL 32803
Grant Number
NH25PS004342-04-01
Participating Start Date
7/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
260 LOOKOUT PL STE 202P
MAITLAND, FL 32751
Pharmacy Comments
Contract Details
Approval Date
3/18/2024
Contract Begin Date
3/19/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
3/18/2024
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