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HOLIDAY CVS, L.L.C.
STD33614 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
North Dale Mabry
Type
Sexually Transmitted Diseases
340B ID
STD33614
Entity Address
6919 North Dale Mabry, Suite 300
Tampa, FL 33614
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2016
Last Recertification Date
5/17/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11239
11521 SR 70 E
BRADENTON, FL 34202
Pharmacy Comments
Contract Details
Approval Date
7/16/2023
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
Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2023
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