Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII33713 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Metro

Type

Ryan White Part B

340B ID

RWII33713

Entity Address

3251 3rd Avenue North
Suite 125
St. Petersburg, FL 33713

Grant Number

X07HA00057

Participating Start Date

7/1/2014

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 # 00160
4260 6TH ST S
SAINT PETERSBURG, FL 33705

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2021
Pharmacy closed

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