Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII34982B Midway Specialty Care Center Inc

Covered Entity Details

Entity Name

Midway Specialty Care Center Inc

Subdivision Name

Type

Ryan White Part B

340B ID

RWII34982B

Entity Address

1801 SE Hillmoor Drive
C207
Port St Lucie, FL 34952

Grant Number

X07HA00057

Participating Start Date

10/1/2018

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02893
4040 PRAIRIE AVE.
MIAMI BEACH, FL 33140

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

Kathryn E Hayden, CFO
(772) 742-9276

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