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HOLIDAY CVS, L.L.C.
STD333083 Light of Hope, Inc.
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Covered Entity Details
Entity Name
Light of Hope, Inc.
Subdivision Name
Light of Hope 2
Type
Sexually Transmitted Diseases
340B ID
STD333083
Entity Address
2021 E Commercial Blvd.
205
Fort Lauderdale, FL 33308
Grant Number
NH25PS004342
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04069
4725 N OCEAN DR
LAUDERDALE BY THE SEA, FL 33308
Pharmacy Comments
Contract Details
Approval Date
1/8/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristin Renae, Vice President
(954) 776-9992
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/8/2024
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