Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH04168S FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.

Covered Entity Details

Entity Name

FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.

Subdivision Name

EAST FORT MYERS MEDICAL OFFICE

Type

HRSA-Funded Health Center

340B ID

CH04168S

Entity Address

4040 PALM BEACH BLVD
Suite A
FORT MYERS, FL 33916-3470

Grant Number

H80CS00185

Participating Start Date

1/1/2013

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03296
4710 PALM BEACH BLVD
FORT MYERS, FL 33905

Pharmacy Comments

Contract Details

Approval Date

1/16/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Carrie Poulsom, VP & Chief Pharmacy Officer
(239) 344-2321

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/16/2024

340B Drug Pricing Program Database