Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD333341 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Dixie Hwy

Type

Sexually Transmitted Diseases

340B ID

STD333341

Entity Address

5333 N. Dixie Hwy
Suite 110
Fort Lauderdale, FL 33334

Grant Number

1 NH25PS005131-01-00

Participating Start Date

1/1/2018

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03635
1501 S FEDERAL HWY
POMPANO BEACH, FL 33062

Pharmacy Comments

Contract Details

Approval Date

1/22/2019

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

1/22/2019

340B Drug Pricing Program Database