Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII34982C Midway Specialty Care Center Inc

Covered Entity Details

Entity Name

Midway Specialty Care Center Inc

Subdivision Name

Type

Ryan White Part B

340B ID

RWII34982C

Entity Address

5701 Overseas Highway
Ste # 10
Marathon, FL 33050

Grant Number

X07HA00057

Participating Start Date

4/1/2020

Last Recertification Date

2/8/2021

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02893
4040 PRAIRIE AVE.
MIAMI BEACH, FL 33140

Pharmacy Comments

Contract Details

Approval Date

2/25/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kathryn E Hayden, CFO
(772) 742-9276

Contract Pharmacy Representative

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

Signed By Date

1/15/2020

340B Drug Pricing Program Database