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HOLIDAY CVS, L.L.C.
CH04431BV MCR Health, Inc.
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Covered Entity Details
Entity Name
MCR Health, Inc.
Subdivision Name
Riverside Medical Services 3300
Type
HRSA-Funded Health Center
340B ID
CH04431BV
Entity Address
300 Riverside Dr E Ste 3300
Bradenton, FL 34208-1024
Grant Number
H80CS00097
Participating Start Date
7/1/2022
Last Recertification Date
2/20/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11239
11521 SR 70 E
BRADENTON, FL 34202
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2025
Business decision by covered entity and/or pharmacy
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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