Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH04550R PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Covered Entity Details

Entity Name

PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Subdivision Name

Premier Community HealthCare Group, Inc. Mobile Dental Clinic #2

Type

HRSA-Funded Health Center

340B ID

CH04550R

Entity Address

37944 Pasco Ave
Dade City, FL 33525-4202

Grant Number

H80CS00101

Participating Start Date

1/1/2022

Last Recertification Date

2/14/2025

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

10/7/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

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

10/6/2021

340B Drug Pricing Program Database