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HOLIDAY CVS, L.L.C.
CH040330 Jessie Trice Community Health System, Inc,
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Covered Entity Details
Entity Name
Jessie Trice Community Health System, Inc,
Subdivision Name
JTCHS - Fatima Zafar MD Health & Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH040330
Entity Address
5361 NW 22nd Ave
Miami, FL 33142-8035
Grant Number
H80CS00732
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05786
16550 NE 6TH AVE, NORTH
MIAMI, FL 33162
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Annie Neasman, President & CEO
(305) 805-1700 Ext: 1000
Contract Pharmacy Representative
CVS
Meagan Stevens, Sales Executive
(407) 457-2409
Signed By Date
10/14/2020
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