Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH043823L BREVARD HEALTH ALLIANCE INC., THE

Covered Entity Details

Entity Name

BREVARD HEALTH ALLIANCE INC., THE

Subdivision Name

BHA Malabar Clinic

Type

HRSA-Funded Health Center

340B ID

CH043823L

Entity Address

775 Malabar Rd
Malabar, FL 32950-3120

Grant Number

H80CS04213

Participating Start Date

4/1/2012

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06014
1696 S FISKE BLVD.
ROCKLEDGE, FL 32955

Pharmacy Comments

Contract Details

Approval Date

1/11/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/4/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Richard Austin Helton, CEO
(321) 241-6868

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/11/2019

340B Drug Pricing Program Database