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HOLIDAY CVS, L.L.C.
DSH010087 USA Health University Hospital
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Covered Entity Details
Entity Name
USA Health University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010087
Entity Address
2451 University Hospital Drive
MOBILE, AL 36617
Medicare Provider Number
010087
Participating Start Date
10/1/2003
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04015
302 E. JAMES LEE BLVD.
CRESTVIEW, FL 32539
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benny J Stover, USA Health, CFO
(251) 445-9164
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2021
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