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HOLIDAY CVS, L.L.C.
STD338441 Diversity Healthcare
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Covered Entity Details
Entity Name
Diversity Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD338441
Entity Address
1011 E Main St Suite A
Haines City, FL 33844
Grant Number
NH25PS005131
Participating Start Date
7/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00262
400 6TH ST NW
WINTER HAVEN, FL 33881
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clayton Dale Reedy, Owner/Provider
(937) 307-7891
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2024
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