Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD33308 Light Of Hope, Inc.

Covered Entity Details

Entity Name

Light Of Hope, Inc.

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD33308

Entity Address

3012 E Commercial Blvd.
Fort Lauderdale, FL 33308

Grant Number

NH25PS004342

Participating Start Date

7/1/2019

Last Recertification Date

5/6/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03905
3 S POMPANO PKWY
POMPANO BEACH, FL 33069

Pharmacy Comments

Contract Details

Approval Date

1/17/2023

Contract Begin Date

1/23/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stephen A Renae, Medical Director
(954) 776-9992 Ext: 100

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