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HOLIDAY CVS, L.L.C.
DSH100025 SACRED HEART HEALTH SYSTEM
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Covered Entity Details
Entity Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100025
Entity Address
5151 NORTH 9TH AVENUE
PENSACOLA, FL 32504
Medicare Provider Number
100025
Participating Start Date
7/1/2003
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16207
4711 BAYOU BLVD
PENSACOLA, FL 32503
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Henry Stovall, President
(850) 416-7681
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/7/2017
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