Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII32117 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Daytona

Type

Ryan White Part B

340B ID

RWII32117

Entity Address

1125 N. Nova Rd.
Daytona Beach, FL 32117

Grant Number

X07HA00057

Participating Start Date

7/1/2014

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05912
1891 LPGA BLVD.
DAYTONA BEACH, FL 32117

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

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

4/15/2021

340B Drug Pricing Program Database