Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
SCH100106-00 DOCTORS MEMORIAL

Covered Entity Details

Entity Name

DOCTORS MEMORIAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH100106-00

Entity Address

333 BYRON BUTLER PARKWAY
PERRY, FL 32347

Medicare Provider Number

100106

Participating Start Date

10/1/2019

Last Recertification Date

8/23/2023

Entity Termination Date

11/16/2023

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04472
105 WEST HAMPTON SPRINGS AVE
PERRY, FL 32347

Pharmacy Comments

Contract Details

Approval Date

10/9/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/16/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Thomas J. Stone, Chief Executive Officer
(850) 584-0886

Contract Pharmacy Representative

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

Signed By Date

10/9/2019

340B Drug Pricing Program Database