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HOLIDAY CVS, L.L.C.
STD328192 Crew Community Health, Inc
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Covered Entity Details
Entity Name
Crew Community Health, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD328192
Entity Address
8601 Commodity Circle
103
Orlando, FL 32819
Grant Number
NH25PS004342
Participating Start Date
9/12/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02188
209 S TEMPLE ST
STARKE, FL 32091
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Chad Thomas Stowers, President
(407) 605-2253
Contract Pharmacy Representative
wellpartner
Crissy Levisay, Account Manager
(239) 322-4188
Signed By Date
4/11/2023
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