Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWI33603 Empath Health, Inc.

Covered Entity Details

Entity Name

Empath Health, Inc.

Subdivision Name

AIDS Service Association of Pinellas, Inc. dba EPIC

Type

Ryan White Part A

340B ID

RWI33603

Entity Address

4703 N FLORIDA AVE
TAMPA, FL 33603

Grant Number

H89HA00024

Participating Start Date

7/1/2015

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00613
9202 N FLORIDA AVE
TAMPA, FL 33612

Pharmacy Comments

Contract Details

Approval Date

7/7/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Saida Bouhamid, Chief Mission Financial Officer
(727) 523-3339

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/7/2023

340B Drug Pricing Program Database