Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD33712 Empath Health, Inc.

Covered Entity Details

Entity Name

Empath Health, Inc.

Subdivision Name

AIDS Service Association of Pinellas dba EPIC

Type

Sexually Transmitted Diseases

340B ID

STD33712

Entity Address

3050 1st Ave S
St. Petersburg, FL 33712

Grant Number

1NU62PS924687-1-00

Participating Start Date

4/1/2018

Last Recertification Date

5/9/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03960
3765 ULMERTON RD
CLEARWATER, FL 33762

Pharmacy Comments

Contract Details

Approval Date

7/7/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

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