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HOLIDAY CVS, L.L.C.
DSH100276 Broward Health Coral Springs
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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 # 04681
3724 NORTH OCEAN BLVD.
FORT LAUDERDALE, FL 33308
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
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