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HOLIDAY CVS, L.L.C.
RRC330011-00 OUR LADY OF LOURDES MEMORIAL HOSP
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Covered Entity Details
Entity Name
OUR LADY OF LOURDES MEMORIAL HOSP
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330011-00
Entity Address
169 RIVERSIDE DRIVE
BINGHAMTON, NY 13905
Medicare Provider Number
330011
Participating Start Date
7/1/2024
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03171
602 W MAIN ST
INVERNESS, FL 34450
Pharmacy Comments
Contract Details
Approval Date
5/1/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathryn Connerton, CEO
(607) 798-5328
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2024
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