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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
FQHCLA407J Metropolitan Charities, Inc.
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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
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
12/28/2023
Contract Begin Date
12/28/2023
Carve-In Effective Date
Contract Comments
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
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