Contract Pharmacy Details

WALGREEN CO.
FQHCLA407A Metropolitan Charities, Inc.

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09031
3851 4TH ST NORTH
ST PETERSBURG, FL 33703

Pharmacy Comments

Contract Details

Approval Date

7/9/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Priya Rajkumar, Chief Executive Officer
(727) 321-3854 Ext: 1230

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/9/2020

340B Drug Pricing Program Database