Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD327634 Home Of Grace INC

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 # 03114
2400 ENTERPRISE RD.
ORANGE CITY, FL 32763

Pharmacy Comments

Contract Details

Approval Date

2/15/2023

Contract Begin Date

2/16/2023

Carve-In Effective Date

Contract Comments

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

2/15/2023

340B Drug Pricing Program Database