Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH490024 CARILION MEDICAL CENTER

Covered Entity Details

Entity Name

CARILION MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH490024

Entity Address

1906 BELLEVIEW AVE SE
ROANOKE, VA 24014

Medicare Provider Number

490024

Participating Start Date

10/1/2007

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16211
1400A TAMIAMI TRL
PORT CHARLOTTE, FL 33948

Pharmacy Comments

Contract Details

Approval Date

10/19/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tim Auwarter, VP Hospital Operations
(540) 981-7804

Contract Pharmacy Representative

CVS Health
Christian Reid, 340B Program Director
(401) 770-2118

Signed By Date

10/19/2021

340B Drug Pricing Program Database