Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD336052 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Ybor

Type

Sexually Transmitted Diseases

340B ID

STD336052

Entity Address

2105 N Nebraska Ave
Tampa, FL 33602

Grant Number

1 NH25PS005131-01-00

Participating Start Date

1/1/2016

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03638
10623 GIBSONTON DR
RIVERVIEW, FL 33578

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