Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII34287 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

North Port

Type

Ryan White Part B

340B ID

RWII34287

Entity Address

14243 Tamiami Trail
North Port, FL 34287

Grant Number

X07HA00057

Participating Start Date

1/1/2014

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01120
215 JACARANDA BLVD.
VENICE, FL 34292

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