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HOLIDAY CVS, L.L.C.
DSH100086 BROWARD HEALTH NORTH
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Covered Entity Details
Entity Name
BROWARD HEALTH NORTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100086
Entity Address
201 EAST SAMPLE ROAD
DEERFIELD BEACH, FL 33064
Medicare Provider Number
100086
Participating Start Date
7/1/2022
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02758
255 S. STATE RD. #7
MARGATE, FL 33068
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Ivory Jan Monroe, Interim CFO
(954) 297-9049
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2022
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