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HOLIDAY CVS, L.L.C.
DSH220011 CAMBRIDGE PUBLIC HEALTH COMMISSION
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Covered Entity Details
Entity Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220011
Entity Address
1493 Cambridge Street
CAMBRIDGE, MA 02139
Medicare Provider Number
220011
Participating Start Date
7/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03204
5010 S FLORIDA AVE
LAKELAND, FL 33813
Pharmacy Comments
Contract Details
Approval Date
7/2/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/2/2020
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