Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
CH04550U PREMIER COMMUNITY HEALTHCARE GROUP INC

Covered Entity Details

Entity Name

PREMIER COMMUNITY HEALTHCARE GROUP INC

Subdivision Name

Premier Community HealthCare Group, Inc. - Gulfside Elementary School

Type

HRSA-Funded Health Center

340B ID

CH04550U

Entity Address

2329 Anclote Blvd
Holiday, FL 34691-9739

Grant Number

H80CS00101

Participating Start Date

7/1/2024

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01293
12804 US HWY 301
DADE CITY, FL 33525

Pharmacy Comments

Contract Details

Approval Date

4/15/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Joseph Resnick, CEO
(352) 518-2000 Ext: 9000

Contract Pharmacy Representative

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

Signed By Date

4/12/2024

340B Drug Pricing Program Database