Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII32501 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER PENSACOLA/HIV TESTING SITE

Type

Ryan White Part B

340B ID

RWII32501

Entity Address

4300 BAYOU BLVD
SUITE 17D
PENSACOLA, FL 32503

Grant Number

X07HA00057

Participating Start Date

7/1/2010

Last Recertification Date

2/16/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04015
302 E. JAMES LEE BLVD.
CRESTVIEW, FL 32539

Pharmacy Comments

Contract Details

Approval Date

1/14/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

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

Signed By Date

1/14/2022

340B Drug Pricing Program Database