Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RW400091A University of Florida CARES

Covered Entity Details

Entity Name

University of Florida CARES

Subdivision Name

University of Florida CARES Beaches

Type

Ryan White Part D

340B ID

RW400091A

Entity Address

570 Jacksonville Dr.
Jacksonville, FL 32250

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 # 16195
9041 SOUTHSIDE BLVD
JACKSONVILLE, FL 32256

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

340B Drug Pricing Program Database