Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII33712A 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 B

340B ID

RWII33712A

Entity Address

4600 N. Habana Ave.
Suite 15
Tampa, FL 33614

Grant Number

X07HA00057

Participating Start Date

10/1/2015

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16436
3625 W GANDY BLVD
TAMPA, FL 33611

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