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CAREMARK NEW JERSEY SPECIALTY PHCY, LLC
FQHCLA407K Metropolitan Charities, Inc.
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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
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
1/5/2024
Contract Begin Date
4/1/2024
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
1/5/2024
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