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JTJ MEDICAL SUPPLY, INC
RW133713C Metropolitan Charities, Inc.
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Covered Entity Details
Entity Name
Metropolitan Charities, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RW133713C
Entity Address
2349 Sunset Point Rd
Suite #405
Clearwater, FL 33765
Grant Number
H89HA00024
Participating Start Date
1/1/2017
Last Recertification Date
2/6/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
3251 3RD AVE N
ST PETERSBURG, FL 33713
Pharmacy Comments
Contract Details
Approval Date
10/25/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
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