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HOLIDAY CVS, L.L.C.
STD337071 Empath Health, Inc.
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Covered Entity Details
Entity Name
Empath Health, Inc.
Subdivision Name
AIDS Service Association of Pinellas, Inc. dba EPIC
Type
Sexually Transmitted Diseases
340B ID
STD337071
Entity Address
300 49th Street S
St.Petersburg, FL 33707
Grant Number
1NU62PS924687-1-00
Participating Start Date
4/1/2021
Last Recertification Date
5/9/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00104
1 S MISSOURI AVE
CLEARWATER, FL 33756
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
7/1/2024
Covered Entity Terminated
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
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