Contract Pharmacy Details

EXCEL PHARMACY
FQHCLA414 Metro Health Inc

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

EXCEL PHARMACY

Pharmacy Address

EXCEL PHARMACY
3923 S CAPITOL ST SW
UNIT A
WASHINGTON, DC 20032

Pharmacy Comments

Contract Details

Approval Date

10/15/2021

Contract Begin Date

11/8/2021

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

Excel Pharmacy
Melat Debela, Owner
(202) 652-1776

Signed By Date

10/15/2021