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HOLIDAY CVS, L.L.C.
FQHCLA356 Whole Family Health Center, Inc.
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Covered Entity Details
Entity Name
Whole Family Health Center, Inc.
Subdivision Name
Whole Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA356
Entity Address
725 N US Highway 1
Fort Pierce, FL 34950-9125
Grant Number
LALCS31468
Participating Start Date
10/24/2017
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16180
880 SAND LAKE RD
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
6/29/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marie Andress, CEO
(772) 925-8200
Contract Pharmacy Representative
Whole Family Health Center
Jamie Lynnette Merritt, Vice President
(772) 925-8200 Ext: 104
Signed By Date
6/29/2020
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