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HOLIDAY CVS, L.L.C.
STD322023 FIRST COAST COMMUNITY DEVELOPMENT, INC
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Covered Entity Details
Entity Name
FIRST COAST COMMUNITY DEVELOPMENT, INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD322023
Entity Address
525 N. Newnan Street
Jacksonville, FL 32202
Grant Number
6NU62PS924532-05-01
Participating Start Date
5/25/2022
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05004
5634 MERRILL RD.
JACKSONVILLE, FL 32277
Pharmacy Comments
Contract Details
Approval Date
8/31/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Charlie Bernard Griffin, Executive Director
(904) 866-7483
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
8/31/2022
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