Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH100034 MOUNT SINAI MEDICAL CENTER

Covered Entity Details

Entity Name

MOUNT SINAI MEDICAL CENTER

Subdivision Name

MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.

Type

Disproportionate Share Hospital

340B ID

DSH100034

Entity Address

4300 Alton Road
MIAMI BEACH, FL 33140

Medicare Provider Number

100034

Participating Start Date

4/1/2007

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02893
4040 PRAIRIE AVE.
MIAMI BEACH, FL 33140

Pharmacy Comments

Contract Details

Approval Date

4/14/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/30/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

4/14/2014

340B Drug Pricing Program Database