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HOLIDAY CVS, L.L.C.
CH03406BK Primary Health Network
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Covered Entity Details
Entity Name
Primary Health Network
Subdivision Name
Oil City Health Center
Type
HRSA-Funded Health Center
340B ID
CH03406BK
Entity Address
811 Grandview Rd Ste 100
Oil City, PA 16301-2077
Grant Number
H80CS00663
Participating Start Date
4/1/2020
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01293
12804 US HWY 301
DADE CITY, FL 33525
Pharmacy Comments
Contract Details
Approval Date
4/17/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Francis Burich, Acting CEO
(724) 342-3002
Contract Pharmacy Representative
CVS
Gabrielle Lagana, Implementation Consultant
(212) 419-4049
Signed By Date
4/17/2020
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