Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
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

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05815
102 S. DALE MABRY HIGHWAY
TAMPA, FL 33609

Pharmacy Comments

Contract Details

Approval Date

12/28/2023

Contract Begin Date

12/28/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/28/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Priya Rajkumar, Chief Executive Officer
(727) 321-3854 Ext: 1230

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

12/28/2023

340B Drug Pricing Program Database