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HOLIDAY CVS, L.L.C.
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
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00613
9202 N FLORIDA AVE
TAMPA, FL 33612
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/11/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Priya Rajkumar, Chief Executive Officer
(727) 321-3854 Ext: 1230
Contract Pharmacy Representative
Walgreen Co.
Christine Precht, 340B Client Relationship Analysit
(847) 964-6560
Signed By Date
1/10/2024
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