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HOLIDAY CVS, L.L.C.
RW4248241 Gateway Community Services, Inc
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Covered Entity Details
Entity Name
Gateway Community Services, Inc
Subdivision Name
Type
Ryan White Part D
340B ID
RW4248241
Entity Address
555 Stockton St.
Jacksonville, FL 32204
Grant Number
H12HA24824
Participating Start Date
7/1/2019
Last Recertification Date
2/7/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17237
463737 STATE RD 200
YULEE, FL 32097
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
4/21/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tina M. Bottini, Senior Asst. Dean, Research
(904) 244-9478
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2022
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