Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD322021 Positive Health Alliance, Inc

Covered Entity Details

Entity Name

Positive Health Alliance, Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD322021

Entity Address

720 N Ocean Street
Jacksonville, FL 32202

Grant Number

NH25PS005131

Participating Start Date

5/8/2020

Last Recertification Date

5/28/2021

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS/PHARMACY # 10078
2101 E. HALLANDALE BEACH BLVD.
HALLANDALE BEACH, FL 33009

Pharmacy Comments

Contract Details

Approval Date

5/6/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/4/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Gary G Kogan, Executive Director
(888) 752-2267

Contract Pharmacy Representative

CVS Health
Christian Reid, 340B Program Director
(401) 770-2118

Signed By Date

4/14/2020

340B Drug Pricing Program Database