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HOLIDAY CVS, L.L.C.
STD327634 Home Of Grace INC
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Covered Entity Details
Entity Name
Home Of Grace INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD327634
Entity Address
955 Town Center Drive
Suite 100
Orange City, FL 32763
Grant Number
H25PS005131
Participating Start Date
1/4/2023
Last Recertification Date
5/22/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00214
901 N WOODLAND BLVD
DELAND, FL 32720
Pharmacy Comments
Contract Details
Approval Date
1/4/2023
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/4/2023
Agreement registered in error
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
11/7/2022
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