Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH100276 Broward Health Coral Springs

Covered Entity Details

Entity Name

Broward Health Coral Springs

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100276

Entity Address

3000 CORAL HILLS DRIVE
CORAL SPRINGS, FL 33065

Medicare Provider Number

100276

Participating Start Date

10/1/2007

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04201
2240 EAST SUNRISE BLVD
FORT LAUDERDALE, FL 33304

Pharmacy Comments

Contract Details

Approval Date

7/12/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Modesto Gato, Chief Financial Officer
(786) 273-6188

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/12/2022

340B Drug Pricing Program Database