Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH040210 CENTRAL FLORIDA HEALTH CARE, INC.

Covered Entity Details

Entity Name

CENTRAL FLORIDA HEALTH CARE, INC.

Subdivision Name

CFHC Avon Park Primary Care

Type

HRSA-Funded Health Center

340B ID

CH040210

Entity Address

950 COUNTY ROAD 17-A, WEST
AVON PARK, FL 33825-2164

Grant Number

H80CS00423

Participating Start Date

1/1/2000

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 17430
5000 GRANDVIEW PKWY
DAVENPORT, FL 33837

Pharmacy Comments

Contract Details

Approval Date

1/13/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

ANN CLAUSSEN, CEO
(863) 291-5115

Contract Pharmacy Representative

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

Signed By Date

1/13/2022

340B Drug Pricing Program Database