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HOLIDAY CVS, L.L.C.
STD33936 Blue Star Health
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Covered Entity Details
Entity Name
Blue Star Health
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33936
Entity Address
1154 Lee Blvd Unit 3
Lehigh Acres, FL 33936
Grant Number
NH25PS005131
Participating Start Date
1/1/2021
Last Recertification Date
6/2/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02803
4001 E. BUSCH BLVD.
TAMPA, FL 33617
Pharmacy Comments
Contract Details
Approval Date
11/17/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Fabio Ruiz, CEO
(866) 725-4642
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2020
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