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HOLIDAY CVS, L.L.C.
CH04168D FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
FORT MYERS CENTER - DOWNTOWN
Type
HRSA-Funded Health Center
340B ID
CH04168D
Entity Address
2232 GRAND AVE
FORT MYERS, FL 33901-3717
Grant Number
H80CS00185
Participating Start Date
4/1/1995
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04726
24200 VETERANS BLVD
PORT CHARLOTTE, FL 33954
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frank Mazzeo Jr., CEO
(239) 278-3600
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2018
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