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MARYLAND CVS PHARMACY, L.L.C.
FQHCLA414A Metro Health Inc
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Covered Entity Details
Entity Name
Metro Health Inc
Subdivision Name
Metro Health Secondary Site
Type
Health Center Program Look-Alike
340B ID
FQHCLA414A
Entity Address
801 Pennsylvania Ave SE Ste 201
Washington, DC 20003-2152
Grant Number
LALCS39530
Participating Start Date
1/1/2021
Last Recertification Date
2/17/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03789
4840 MARLBORO PIKE
CAPITOL HEIGHTS, MD 20743
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Miguel McInnis, CEO
(202) 838-9271
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
10/14/2020
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