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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
FQHCLA407C Metropolitan Charities, Inc.
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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
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
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 Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/12/2022
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