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HOLIDAY CVS, L.L.C.
STD32605 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Gainesville
Type
Sexually Transmitted Diseases
340B ID
STD32605
Entity Address
6717 NW 11th Place
Suite B
Gainesville, FL 32605
Grant Number
1 NH25PS005131-01-00
Participating Start Date
4/5/2019
Last Recertification Date
5/29/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05181
2303 SW 75TH ST
GAINESVILLE, FL 32607
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
4/1/2019
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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