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GENOA HEALTHCARE LLC
STD33410 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
Palm Beach
Type
Sexually Transmitted Diseases
340B ID
STD33410
Entity Address
4360 Northlake Blvd.
Suite 115
Palm Beach Gardens, FL 33410
Grant Number
NH25PS004342-04-01
Participating Start Date
10/1/2021
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
4/12/2024
Contract Begin Date
7/1/2024
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
4/12/2024
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