Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD336141 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Habana

Type

Sexually Transmitted Diseases

340B ID

STD336141

Entity Address

4729 N Habana Ave
Tampa, FL 33614

Grant Number

1 NH25PS005131-01-00

Participating Start Date

4/1/2016

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16436
3625 W GANDY BLVD
TAMPA, FL 33611

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