Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
STD328091 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)

Covered Entity Details

Entity Name

Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)

Subdivision Name

Orlando

Type

Sexually Transmitted Diseases

340B ID

STD328091

Entity Address

130 E Marks St
Orlando, FL 32803

Grant Number

NH25PS004342-04-01

Participating Start Date

7/1/2020

Last Recertification Date

5/7/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00204
5899 ORANGE BLOSSOM TRL
ORLANDO, FL 32839

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

340B Drug Pricing Program Database