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TAMPA FAMILY PHARMACY
FQHCLA407D Metropolitan Charities, Inc.
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Covered Entity Details
Entity Name
Metropolitan Charities, Inc.
Subdivision Name
METRO Central
Type
Health Center Program Look-Alike
340B ID
FQHCLA407D
Entity Address
2237 Central Ave
Saint Petersburg, FL 33713-8844
Grant Number
LALCS35348
Participating Start Date
8/4/2021
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
TAMPA FAMILY PHARMACY
Pharmacy Address
12470 TELECOM DR STE 110W
TEMPLE TERRACE, FL 33637
Pharmacy Comments
Contract Details
Approval Date
8/4/2021
Contract Begin Date
10/1/2021
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
Tampa Family Pharmacy
Hansil Kalaria, VP of Pharmacy Operations
(813) 871-5161 Ext: 34228
Signed By Date
8/3/2021
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