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HOLIDAY CVS, L.L.C.
STD32724 Home Of Grace INC
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Covered Entity Details
Entity Name
Home Of Grace INC
Subdivision Name
Home Of Grace INC
Type
Sexually Transmitted Diseases
340B ID
STD32724
Entity Address
230 E New York Ave
Deland, FL 32724
Grant Number
H25PS005131
Participating Start Date
7/20/2022
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03114
2400 ENTERPRISE RD.
ORANGE CITY, FL 32763
Pharmacy Comments
Contract Details
Approval Date
7/27/2022
Contract Begin Date
7/29/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adaobi Oguchi, President
(407) 402-6324
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/27/2022
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