Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD32514 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Gulf Coast

Type

Sexually Transmitted Diseases

340B ID

STD32514

Entity Address

2120 E. Johnson Ave.
Suite 105
Pensacola, FL 32514

Grant Number

1 NH25PS005131-01-00

Participating Start Date

7/1/2022

Last Recertification Date

5/27/2024

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04458
8100 N DAVIS HWY
PENSACOLA, FL 32514

Pharmacy Comments

Contract Details

Approval Date

5/10/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Covered Entity Terminated

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

4/21/2022

340B Drug Pricing Program Database