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HOLIDAY CVS, L.L.C.
STD334041 INTEGRATED HEALTHCARE SYSTEMS RIVIERA INC
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Covered Entity Details
Entity Name
INTEGRATED HEALTHCARE SYSTEMS RIVIERA INC
Subdivision Name
INTEGRATED HEALTHCARE SYSTEMS
Type
Sexually Transmitted Diseases
340B ID
STD334041
Entity Address
800 N Sapodilla Avenue
STE 3
West Palm Beach, FL 33401-6155
Grant Number
NH25PS005131
Participating Start Date
4/1/2020
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17484
1760 PALM BEACH LAKES BLVD
WEST PALM BEACH, FL 33401
Pharmacy Comments
Contract Details
Approval Date
3/2/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Monique D Brown Wellons, CEO
(561) 510-0471
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2020
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