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PENNSYLVANIA CVS PHARMACY, L.L.C.
FQHCLA356A Whole Family Health Center, Inc.
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Covered Entity Details
Entity Name
Whole Family Health Center, Inc.
Subdivision Name
Whole Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA356A
Entity Address
981 37th Place
Vero Beach, FL 32960-6541
Grant Number
LALCS31468
Participating Start Date
10/24/2017
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02704
4849 MARKET ST.
PHILADELPHIA, PA 19139
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
4/8/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marie Andress, CEO
(772) 925-8200
Contract Pharmacy Representative
Whole Family Health Center
Jamie Lynnette Merritt, Vice President
(772) 925-8200 Ext: 104
Signed By Date
1/14/2022
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