Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWI606161D AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Chicago - Lakeview

Type

Ryan White Part A

340B ID

RWI606161D

Entity Address

3311 N. Halsted Street
Chicago, IL 60657

Grant Number

H89HA00008

Participating Start Date

1/1/2021

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 17089
3700 BRADFORDVILLE RD
TALLAHASSEE, FL 32309

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

340B Drug Pricing Program Database