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HOLIDAY CVS, L.L.C.
FQHCLA407B Metropolitan Charities, Inc.
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Covered Entity Details
Entity Name
Metropolitan Charities, Inc.
Subdivision Name
METRO New Port Richey
Type
Health Center Program Look-Alike
340B ID
FQHCLA407B
Entity Address
4747 US Highway 19
New Port Richey, FL 34652-4945
Grant Number
LALCS35348
Participating Start Date
4/14/2020
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #10482
822 WEST PENSACOLA STREET
TALLAHASSEE, FL 32304-8036
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
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
1/10/2024
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