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HOLIDAY CVS, L.L.C.
FQHCLA443A SPACE COAST HEALTH CENTERS INC
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Covered Entity Details
Entity Name
SPACE COAST HEALTH CENTERS INC
Subdivision Name
Space Coast Health Centers Primary Care - Port St. John
Type
Health Center Program Look-Alike
340B ID
FQHCLA443A
Entity Address
5005 Port St John Pkwy Ste 2400
Cocoa, FL 32927-4305
Grant Number
LALCS45787
Participating Start Date
4/1/2023
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03151
100 N MIRAMAR AVE
INDIALANTIC, FL 32903
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arvin H Lewis, CEO
(321) 346-8031
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2024
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