Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD336031 Empath Health, Inc.

Covered Entity Details

Entity Name

Empath Health, Inc.

Subdivision Name

AIDS Service Association of Pinellas, Inc. dba EPIC

Type

Sexually Transmitted Diseases

340B ID

STD336031

Entity Address

4703 N Florida Ave
Tampa, FL 33603

Grant Number

1NU62PS924687-1-00

Participating Start Date

4/1/2022

Last Recertification Date

5/9/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05207
2725 N MACDILL AVE
TAMPA, FL 33607

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