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HOLIDAY CVS, L.L.C.
STD33811 Pineapple Healthcare
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Covered Entity Details
Entity Name
Pineapple Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33811
Entity Address
1724 33rd Street Suite 100
Orlando, FL 32839
Grant Number
NH25PS005131
Participating Start Date
9/21/2021
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16180
880 SAND LAKE RD
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
4/1/2022
Contract Begin Date
4/5/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ethan Michael Suarez, President
(407) 839-7278
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2022
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