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HOLIDAY CVS, L.L.C.
CH04037G FLORIDA COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
FLORIDA COMMUNITY HEALTH CENTER INC
Subdivision Name
PORT ST. LUCIE ADULT AND SENIOR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04037G
Entity Address
1701 S.E. HILLMOOR DR. STE 19
PORT ST. LUCIE, FL 34952
Grant Number
H80CS00798
Participating Start Date
10/1/2012
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04254
301 NE PRIMA VISTA BLVD
PORT SAINT LUCIE, FL 34983
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/25/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Margaret Virginia Russell, VP & CFO
(561) 844-9443 Ext: 1003
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2023
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