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HOLIDAY CVS, L.L.C.
FQHCLA407L Metropolitan Charities, Inc.
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Covered Entity Details
Entity Name
Metropolitan Charities, Inc.
Subdivision Name
METRO at Fletcher Avenue
Type
Health Center Program Look-Alike
340B ID
FQHCLA407L
Entity Address
3500 E Fletcher Ave
Suite 302
Tampa, FL 33613-4797
Grant Number
LALCS35348
Participating Start Date
12/21/2023
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03260
7325 STATE ROAD 54
NEW PORT RICHEY, FL 34653
Pharmacy Comments
Contract Details
Approval Date
12/28/2023
Contract Begin Date
12/28/2023
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
12/28/2023
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