Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII342371H CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

FWB

Type

Ryan White Part B

340B ID

RWII342371H

Entity Address

1825 Hurlburt Rd
Suite 14
Fort Walton Beach, FL 32547

Grant Number

X07HA00057

Participating Start Date

1/1/2020

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04177
2100 WEST CERVANTES
PENSACOLA, FL 32505

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111

Contract Pharmacy Representative

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

Signed By Date

7/15/2020

340B Drug Pricing Program Database