Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD347444 Sunshine Specialty Health Outreach Foundation

Covered Entity Details

Entity Name

Sunshine Specialty Health Outreach Foundation

Subdivision Name

Gastroenterology and Nutrition

Type

Sexually Transmitted Diseases

340B ID

STD347444

Entity Address

901 E Oak Street
Suite C
Kissimmee, FL 34744

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

340B Drug Pricing Program Database