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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
5/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03141
5190 S CONWAY RD
ORLANDO, FL 32812
Pharmacy Comments
Contract Details
Approval Date
9/6/2023
Contract Begin Date
9/14/2023
Carve-In Effective Date
Contract Comments
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
7/1/2023
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