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HOLIDAY CVS, L.L.C.
DSH100088 BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100088
Entity Address
800 PRUDENTIAL DRIVE
JACKSONVILLE, FL 32207
Medicare Provider Number
100088
Participating Start Date
7/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01114
4475 SAN JUAN AVENUE
JACKSONVILLE, FL 32210
Pharmacy Comments
Contract Details
Approval Date
1/17/2022
Contract Begin Date
1/27/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Finnegan, Senior Vice President of Finance/Treasury
(904) 202-3270
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2022
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