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HOLIDAY CVS, L.L.C.
STD330304 Doctors United Group Inc
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Covered Entity Details
Entity Name
Doctors United Group Inc
Subdivision Name
Advanced Wellness
Type
Sexually Transmitted Diseases
340B ID
STD330304
Entity Address
12 Palm Plaza
Suite C
Homestead, FL 33030
Grant Number
NH25PS004342
Participating Start Date
12/12/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00508
1205 W VINE ST
KISSIMMEE, FL 34741
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
Khadijah Carbon, Vice President
(305) 879-9749
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2024
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