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HOLIDAY CVS, L.L.C.
CH04431AF MCR Health, Inc.
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Covered Entity Details
Entity Name
MCR Health, Inc.
Subdivision Name
PALMETTO FAMILY HEALTHCARE CTR
Type
HRSA-Funded Health Center
340B ID
CH04431AF
Entity Address
404 7TH St W
Palmetto, FL 34221-5209
Grant Number
H80CS00097
Participating Start Date
4/1/2013
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02030
301 S. 6TH AVE.
WAUCHULA, FL 33873
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MONICA RIDER, Chief Medical Officer
(941) 999-0310
Contract Pharmacy Representative
Montana CVS Pharmacy, LLC
Christian Reid, Senior Director
(401) 770-2118
Signed By Date
7/15/2024
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