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HOLIDAY CVS, L.L.C.
STD3280610 Sunshine Specialty Health Outreach Foundation
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Covered Entity Details
Entity Name
Sunshine Specialty Health Outreach Foundation
Subdivision Name
Gastroenterology and Nutrition
Type
Sexually Transmitted Diseases
340B ID
STD3280610
Entity Address
2880 S Osceola Ave
Orlando, FL 32806
Grant Number
5NU62PS9224532-02
Participating Start Date
4/1/2023
Last Recertification Date
5/7/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00204
5899 ORANGE BLOSSOM TRL
ORLANDO, FL 32839
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/25/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jillian Hall, CEO
(407) 888-5980
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/6/2023
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