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HOLIDAY CVS, L.L.C.
STD336073 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Lakeland
Type
Sexually Transmitted Diseases
340B ID
STD336073
Entity Address
3900 S. Florida Avenue
Suite 205
Lakeland, FL 33813
Grant Number
NH25PS004342-04-01
Participating Start Date
1/1/2021
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16979
4005 HIGHWAY 98 N
LAKELAND, FL 33809
Pharmacy Comments
Contract Details
Approval Date
7/14/2024
Contract Begin Date
8/12/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2024
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