Contract Pharmacy Details

CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
FQHCLA407M Metropolitan Charities, Inc.

Covered Entity Details

Entity Name

Metropolitan Charities, Inc.

Subdivision Name

METRO South St. Pete

Type

Health Center Program Look-Alike

340B ID

FQHCLA407M

Entity Address

2116 34th St S
Saint Petersburg, FL 33711-3224

Grant Number

LALCS35348

Participating Start Date

12/21/2023

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

CAREMARK NEW JERSEY SPECIALTY PHCY, LLC

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
180 PASSAIC AVE UNIT B-5
FAIRFIELD, NJ 07004

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