Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH340127 GRANVILLE MEDICAL CENTER

Covered Entity Details

Entity Name

GRANVILLE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340127

Entity Address

1010 COLLEGE STREET
OXFORD, NC 27565

Medicare Provider Number

340127

Participating Start Date

7/1/2004

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00536
3187 S CONGRESS AVE
PALM SPRINGS, FL 33461

Pharmacy Comments

Contract Details

Approval Date

10/13/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/20/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Adam West McConnell, CEO
(919) 690-3402

Contract Pharmacy Representative

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

Signed By Date

10/13/2020

340B Drug Pricing Program Database