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HOLIDAY CVS, L.L.C.
STD334621 Midway Specialty Care Center
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Covered Entity Details
Entity Name
Midway Specialty Care Center
Subdivision Name
Sexually Transmitted Diseases
Type
Sexually Transmitted Diseases
340B ID
STD334621
Entity Address
5507 South Congress Ave
150
Atlantis, FL 33462
Grant Number
NH25PS005131
Participating Start Date
10/1/2022
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07923
2873 SW PORT ST. LUCIE BLVD.
PORT SAINT LUCIE, FL 34953
Pharmacy Comments
Contract Details
Approval Date
4/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/16/2023
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