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HOLIDAY CVS, L.L.C.
CHC28370-00 TRI-STATE COMMUNITY HEALTHCARE CENTER
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Covered Entity Details
Entity Name
TRI-STATE COMMUNITY HEALTHCARE CENTER
Subdivision Name
Tri-State Community Healthcare Center
Type
HRSA-Funded Health Center
340B ID
CHC28370-00
Entity Address
1402 BAILEY AVE
NEEDLES, CA 92363-3104
Grant Number
H80CS28370
Participating Start Date
7/1/2017
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03003
71 MARY ESTHER BLVD
MARY ESTHER, FL 32569
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/27/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Aram Manoukian, CEO
(760) 326-0222 Ext: 8186584000
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2020
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