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HOLIDAY CVS, L.L.C.
CAH101315-00 JAY HOSPITAL, INC.
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Covered Entity Details
Entity Name
JAY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101315-00
Entity Address
14114 ALABAMA STREET
Jay, FL 32565-1219
Medicare Provider Number
101315
Participating Start Date
7/1/2024
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17500
2950 S BLUE ANGEL PKWY
PENSACOLA, FL 32506
Pharmacy Comments
Contract Details
Approval Date
6/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew L. Terry, Vice President Revenue Management
(850) 469-7643
Contract Pharmacy Representative
CVS Health
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/15/2024
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