Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
FQHCLA407G Metropolitan Charities, Inc.

Covered Entity Details

Entity Name

Metropolitan Charities, Inc.

Subdivision Name

METRO North St. Pete

Type

Health Center Program Look-Alike

340B ID

FQHCLA407G

Entity Address

11201 Corporate Cir N, Ste 140
Saint Petersburg, FL 33716-3701

Grant Number

LALCS35348

Participating Start Date

10/16/2023

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02760
2911 E. FOWLER AVE.
TAMPA, FL 33612

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

340B Drug Pricing Program Database