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HOLIDAY CVS, L.L.C.
DSH100025 SACRED HEART HEALTH SYSTEM
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Covered Entity Details
Entity Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100025
Entity Address
5151 NORTH 9TH AVENUE
PENSACOLA, FL 32504
Medicare Provider Number
100025
Participating Start Date
7/1/2003
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04440
434 RACETRACK RD NE
FORT WALTON BEACH, FL 32547
Pharmacy Comments
Contract Details
Approval Date
11/17/2022
Contract Begin Date
11/17/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
11/17/2022
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