Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII342371H CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

FWB

Type

Ryan White Part B

340B ID

RWII342371H

Entity Address

1825 Hurlburt Rd
Suite 14
Fort Walton Beach, FL 32547

Grant Number

X07HA00057

Participating Start Date

1/1/2020

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04461
811 N FAIRFIELD DR
PENSACOLA, FL 32506

Pharmacy Comments

Contract Details

Approval Date

4/13/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127

Contract Pharmacy Representative

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

Signed By Date

4/13/2022

340B Drug Pricing Program Database