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TAMPA FAMILY PHARMACY
FQHCLA407A Metropolitan Charities, Inc.
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Covered Entity Details
Entity Name
Metropolitan Charities, Inc.
Subdivision Name
METRO Tampa
Type
Health Center Program Look-Alike
340B ID
FQHCLA407A
Entity Address
2105 N Nebraska Ave
Tampa, FL 33602-2558
Grant Number
LALCS35348
Participating Start Date
4/14/2020
Last Recertification Date
2/9/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
TAMPA FAMILY PHARMACY
Pharmacy Address
12470 TELECOM DR STE 110W
TEMPLE TERRACE, FL 33637
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/7/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Priya Rajkumar, Chief Executive Officer
(727) 321-3854 Ext: 1230
Contract Pharmacy Representative
TFP Wellness Systems
Haley Miller, President
(813) 871-5161
Signed By Date
4/8/2020
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