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HOLIDAY CVS, L.L.C.
STD33055 Benevolence Medical Services,Inc
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Covered Entity Details
Entity Name
Benevolence Medical Services,Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33055
Entity Address
19533 NW 57th ave
miami gardens, FL 33055
Grant Number
5nu62ps924532
Participating Start Date
10/1/2023
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05897
3700 NW 199TH ST.
MIAMI GARDENS, FL 33055
Pharmacy Comments
Contract Details
Approval Date
1/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arshad Ali Mohammed, DIRECTOR
(786) 863-5539
Contract Pharmacy Representative
CAREMARK LLC SPECIALTY
CHRISTIAN REID, SR. DIRECTOR 340B
(401) 770-2118
Signed By Date
1/5/2024
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