Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH140239 Javon Bea Hospital

Covered Entity Details

Entity Name

Javon Bea Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140239

Entity Address

8201 E Riverside Blvd
Rockford, IL 61114

Medicare Provider Number

140239

Participating Start Date

1/1/2008

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16941
2747 GULF TO BAY BLVD
CLEARWATER, FL 33759

Pharmacy Comments

Contract Details

Approval Date

7/17/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Todd Anderson, Vice President Finance
(815) 971-6738

Contract Pharmacy Representative

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

Signed By Date

7/17/2022

340B Drug Pricing Program Database