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HOLIDAY CVS, L.L.C.
STD33308 Light Of Hope, Inc.
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Covered Entity Details
Entity Name
Light Of Hope, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33308
Entity Address
3012 E Commercial Blvd.
Fort Lauderdale, FL 33308
Grant Number
NH25PS004342
Participating Start Date
7/1/2019
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00410
2150 EAST COMMERCIAL BLVD
FORT LAUDERDALE, FL 33308
Pharmacy Comments
Contract Details
Approval Date
4/11/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/11/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Stephen A Renae, Medical Director
(954) 776-9992 Ext: 100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2021
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