Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH330238 NICHOLAS H. NOYES MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

NICHOLAS H. NOYES MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330238

Entity Address

111 CLARA BARTON STREET
DANSVILLE, NY 14437

Medicare Provider Number

330238

Participating Start Date

10/1/2017

Last Recertification Date

8/15/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02030
301 S. 6TH AVE.
WAUCHULA, FL 33873

Pharmacy Comments

Contract Details

Approval Date

4/16/2020

Contract Begin Date

4/21/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jay Maslyn, CFO
(585) 335-4306

Contract Pharmacy Representative

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

Signed By Date

4/16/2020

340B Drug Pricing Program Database