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HOLIDAY CVS, L.L.C.
STD33166 ADVANCE MDCARE COMMUNITY CLINIC INC
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Covered Entity Details
Entity Name
ADVANCE MDCARE COMMUNITY CLINIC INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33166
Entity Address
290 Wesward Drive
Miami Springs, FL 33166
Grant Number
NH25PS004342
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05154
2599 SW 147TH AVE.
MIAMI, FL 33185
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DELIA KENNEDY, AUTHORIZED USER
(786) 556-1397
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2024
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