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HOLIDAY CVS, L.L.C.
RWI33316A CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Jax
Type
Ryan White Part A
340B ID
RWI33316A
Entity Address
4615 Philips Highway
Suite 3
Jacksonville, FL 32207
Grant Number
H89HA00039
Participating Start Date
10/1/2017
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03114
2400 ENTERPRISE RD.
ORANGE CITY, FL 32763
Pharmacy Comments
Contract Details
Approval Date
7/26/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/26/2021
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