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HOLIDAY CVS, L.L.C.
STD339016 Blue Star Health
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Covered Entity Details
Entity Name
Blue Star Health
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD339016
Entity Address
3660 Central Ave Unit 7
Fort Myers, FL 33901
Grant Number
NH25PS005131
Participating Start Date
4/1/2021
Last Recertification Date
6/2/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03941
2403 CLEVELAND AVE
FORT MYERS, FL 33901
Pharmacy Comments
Contract Details
Approval Date
4/4/2022
Contract Begin Date
4/5/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fabio Ruiz, CEO
(866) 725-4642
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/4/2022
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