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HOLIDAY CVS, L.L.C.
RWI33316 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
BH Central
Type
Ryan White Part A
340B ID
RWI33316
Entity Address
1726 SE 3rd Ave
Ft. Lauderdale, FL 33316
Grant Number
H89HA00002
Participating Start Date
10/1/2017
Last Recertification Date
2/25/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS/PHARMACY # 5966
1600 S FEDERAL HIGHWAY
HOLLYWOOD, FL 33020
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
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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