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HOLIDAY CVS, L.L.C.
RWII32606 North Central Florida Health Planning Council dba WellFlorida Council
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Covered Entity Details
Entity Name
North Central Florida Health Planning Council dba WellFlorida Council
Subdivision Name
WellFlorida Council
Type
Ryan White Part B
340B ID
RWII32606
Entity Address
1785 NW 80th Blvd
Gainesville, FL 32606
Grant Number
X07HA00057
Participating Start Date
7/1/2021
Last Recertification Date
2/3/2023
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05169
100 SE 2ND AVE
JASPER, FL 32052
Pharmacy Comments
Contract Details
Approval Date
5/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeffrey Allen Feller, Chief Executive Officer
(352) 214-2164
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2021
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