Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
FQHCLA335 LEE MEMORIAL HEALTH SYSTEM

Covered Entity Details

Entity Name

LEE MEMORIAL HEALTH SYSTEM

Subdivision Name

North Fort Myers Medical Office

Type

Health Center Program Look-Alike

340B ID

FQHCLA335

Entity Address

13279 N CLEVELAND AVE
NORTH FORT MYERS, FL 33903-4818

Grant Number

LALCS00171

Participating Start Date

7/1/2015

Last Recertification Date

1/29/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09996
6391 BAYSHORE RD.
NORTH FORT MYERS, FL 33917

Pharmacy Comments

Contract Details

Approval Date

1/18/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Robert Johns, Executive Director for Lee Community Healthcare
(239) 834-9998

Contract Pharmacy Representative

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

Signed By Date

1/18/2022

340B Drug Pricing Program Database