Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII32501A AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER PENSACOLA /MOBILE TREATMENT/TESTING VAN

Type

Ryan White Part B

340B ID

RWII32501A

Entity Address

4300 BAYOU BLVD
SUITE 17D
Pensacola, FL 32503

Grant Number

X07HA00057

Participating Start Date

7/1/2010

Last Recertification Date

2/16/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04449
6501 CAROLINE ST
MILTON, FL 32570

Pharmacy Comments

Contract Details

Approval Date

7/13/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

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

Signed By Date

7/13/2022

340B Drug Pricing Program Database