Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH04550Q PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Covered Entity Details

Entity Name

PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Subdivision Name

Premier Community HealthCare Group, Inc. - Madison Ave

Type

HRSA-Funded Health Center

340B ID

CH04550Q

Entity Address

6906 Madison St
New Port Richey, FL 34652-1902

Grant Number

H80CS00101

Participating Start Date

10/1/2021

Last Recertification Date

2/1/2024

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01293
12804 US HWY 301
DADE CITY, FL 33525

Pharmacy Comments

Contract Details

Approval Date

7/13/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Joseph Resnick, CEO
(352) 518-2000 Ext: 9000

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/2/2021

340B Drug Pricing Program Database