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HOLIDAY CVS, L.L.C.
DSH100039 BROWARD HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
BROWARD HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100039
Entity Address
1600 SOUTH ANDREWS AVE.
FORT LAUDERDALE, FL 33316
Medicare Provider Number
100039
Participating Start Date
7/1/2003
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05174
1150 NE 26TH ST
WILTON MANORS, FL 33305
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alisa Bert, Interim CFO/VP Financial Operations
(954) 847-7483
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2022
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