Contract Pharmacy Details

Walgreens #21395
FQHCLA407K Metropolitan Charities, Inc.

Covered Entity Details

Entity Name

Metropolitan Charities, Inc.

Subdivision Name

METRO Downtown St. Pete

Type

Health Center Program Look-Alike

340B ID

FQHCLA407K

Entity Address

625 6th Ave S
Suite 305
Saint Petersburg, FL 33701-4662

Grant Number

LALCS35348

Participating Start Date

12/21/2023

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

Walgreens #21395

Pharmacy Address

Walgreens Central Fill #21395
5710 Young Pine Rd
Orlando, FL 32829

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

Walgreen Co.
Christine Precht, 340B Client Relationship Analysit
(847) 964-6560

Signed By Date

12/28/2023

340B Drug Pricing Program Database