Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
FQHCLA407D Metropolitan Charities, Inc.

Covered Entity Details

Entity Name

Metropolitan Charities, Inc.

Subdivision Name

METRO Central

Type

Health Center Program Look-Alike

340B ID

FQHCLA407D

Entity Address

2237 Central Ave
Saint Petersburg, FL 33713-8844

Grant Number

LALCS35348

Participating Start Date

8/4/2021

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

340B Drug Pricing Program Database