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HOLIDAY CVS, L.L.C.
RWI33316E CAN Community Health, Inc
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Covered Entity Details
Entity Name
CAN Community Health, Inc
Subdivision Name
Ybor
Type
Ryan White Part A
340B ID
RWI33316E
Entity Address
2105 N Nebraska Ave
Tampa, FL 33602
Grant Number
H89HA00024
Participating Start Date
10/1/2024
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05069
2668 CRAWFORDVILLE HWY
CRAWFORDVILLE, FL 32327
Pharmacy Comments
Contract Details
Approval Date
8/19/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/26/2024
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