Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
FQHCLA407C Metropolitan Charities, Inc.

Covered Entity Details

Entity Name

Metropolitan Charities, Inc.

Subdivision Name

METRO St. Petersburg

Type

Health Center Program Look-Alike

340B ID

FQHCLA407C

Entity Address

3251 3rd Ave N
Saint Petersburg, FL 33713-8506

Grant Number

LALCS35348

Participating Start Date

4/14/2020

Last Recertification Date

2/9/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02760
2911 E. FOWLER AVE.
TAMPA, FL 33612

Pharmacy Comments

Contract Details

Approval Date

1/10/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/10/2022

340B Drug Pricing Program Database