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MARYLAND CVS PHARMACY, L.L.C.
FQHCLA414 Metro Health Inc
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Covered Entity Details
Entity Name
Metro Health Inc
Subdivision Name
Metro Health Main Site
Type
Health Center Program Look-Alike
340B ID
FQHCLA414
Entity Address
1012 14th St NW Ste 700
Washington, DC 20005-3477
Grant Number
LALCS39530
Participating Start Date
1/1/2021
Last Recertification Date
1/30/2024
Entity Termination Date
4/1/2025
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
4/1/2025
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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