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HOLIDAY CVS, L.L.C.
FQHCLA407 Metropolitan Charities, Inc.
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Covered Entity Details
Entity Name
Metropolitan Charities, Inc.
Subdivision Name
METRO Clearwater
Type
Health Center Program Look-Alike
340B ID
FQHCLA407
Entity Address
18167 US Highway 19 North
Suite 150
Clearwater, FL 33764-6566
Grant Number
LALCS35348
Participating Start Date
4/14/2020
Last Recertification Date
2/21/2025
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
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Priya Rajkumar, Chief Executive Officer
(727) 321-3854 Ext: 1230
Contract Pharmacy Representative
CVS
Walter Jury, Account Manager
(315) 271-5312
Signed By Date
10/12/2023
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