Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
FQHCLA407J Metropolitan Charities, Inc.

Covered Entity Details

Entity Name

Metropolitan Charities, Inc.

Subdivision Name

Metro Seminole Heights

Type

Health Center Program Look-Alike

340B ID

FQHCLA407J

Entity Address

3918 N Highland Ave
Tampa, FL 33603-4724

Grant Number

LALCS35348

Participating Start Date

12/21/2023

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203

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