Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII342371D CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Clearwater

Type

Ryan White Part B

340B ID

RWII342371D

Entity Address

2349 Sunset Point Rd.
Suite 404
Clearwater, FL 33765

Grant Number

X07HA00057

Participating Start Date

7/1/2016

Last Recertification Date

2/25/2022

Entity Termination Date

10/1/2022

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00104
1 S MISSOURI AVE
CLEARWATER, FL 33756

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

340B Drug Pricing Program Database