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HOLIDAY CVS, L.L.C.
RWI33316B CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Plantation
Type
Ryan White Part A
340B ID
RWI33316B
Entity Address
4101 NORTH WEST 3RD COURT
MEDICAL PLAZA
Suite 9
Plantation, FL 33317
Grant Number
H89HA00002
Participating Start Date
1/1/2018
Last Recertification Date
2/25/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03905
3 S POMPANO PKWY
POMPANO BEACH, FL 33069
Pharmacy Comments
Contract Details
Approval Date
1/22/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
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
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