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HOLIDAY CVS, L.L.C.
HV013122 GATEWAY COMMUNITY SERIVES, INC
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Covered Entity Details
Entity Name
GATEWAY COMMUNITY SERIVES, INC
Subdivision Name
Type
Ryan White Part C
340B ID
HV013122
Entity Address
555 Stockton Street
Jacksonville, FL 32204
Grant Number
H76HA01312
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
4/20/2022
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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