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HOLIDAY CVS, L.L.C.
RWI32204A AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Orlando Mobile Clinic
Type
Ryan White Part A
340B ID
RWI32204A
Entity Address
1701 N Mills Avenue
Orlando, FL 32803
Grant Number
H89HA00030
Participating Start Date
4/1/2013
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05853
13960 LANDSTAR BLVD.
ORLANDO, FL 32824
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2023
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