Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD342871 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

North Port

Type

Sexually Transmitted Diseases

340B ID

STD342871

Entity Address

14243 Tamiami Trail
North Port, FL 34287

Grant Number

NU62PS924532

Participating Start Date

4/5/2019

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03107
24 S. BREVARD AVE.
ARCADIA, FL 34266

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