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HOLIDAY CVS, L.L.C.
CH04168H FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
Port Charlotte Pediatric & Dental Office
Type
HRSA-Funded Health Center
340B ID
CH04168H
Entity Address
4300 Kings Hwy STE 500
Port Charlotte, FL 33980-2953
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 # 03122
2480 TAMIAMI TRL
PORT CHARLOTTE, FL 33952
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
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