Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH04550P PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Covered Entity Details

Entity Name

PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Subdivision Name

Premier Community HealthCare Group, Inc. - Dental Clinic #4

Type

HRSA-Funded Health Center

340B ID

CH04550P

Entity Address

10841 LITTLE RD
NEW PORTY RICHEY, FL 34654-2513

Grant Number

H80CS00101

Participating Start Date

1/1/2021

Last Recertification Date

2/14/2023

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01293
12804 US HWY 301
DADE CITY, FL 33525

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Joseph Resnick, CEO
(352) 518-2000 Ext: 9000

Contract Pharmacy Representative

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

Signed By Date

10/15/2020

340B Drug Pricing Program Database