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HOLIDAY CVS, L.L.C.
STD322075 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Jacksonville
Type
Sexually Transmitted Diseases
340B ID
STD322075
Entity Address
4615 Philips Highway
Suite 3
Jacksonville, FL 32207
Grant Number
1 NH25PS005131-01-00
Participating Start Date
7/1/2016
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04422
201 SOUTH SR 19
PALATKA, FL 32177
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2019
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