Contract Pharmacy Details

CAREMARK KANSAS SPECIALTY PHARMACY
FQHCLA407L Metropolitan Charities, Inc.

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

CAREMARK KANSAS SPECIALTY PHARMACY

Pharmacy Address

CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219

Pharmacy Comments

Contract Details

Approval Date

12/28/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Agreement registered in error

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

340B Drug Pricing Program Database