Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH04168R FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.

Covered Entity Details

Entity Name

FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.

Subdivision Name

CAPE CORAL PEDIATRIC OFFICE

Type

HRSA-Funded Health Center

340B ID

CH04168R

Entity Address

305 SW 2nd Ter
Cape Coral, FL 33991-1958

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 # 04224
1003 SANTA BARBARA BLVD
CAPE CORAL, FL 33991

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