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HOLIDAY CVS, L.L.C.
DSH230195 ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital
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Covered Entity Details
Entity Name
ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230195
Entity Address
11800 TWELVE MILE RD.
WARREN, MI 48093
Medicare Provider Number
230195
Participating Start Date
1/1/2021
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03814
4120 HENDERSON BLVD
TAMPA, FL 33629
Pharmacy Comments
Contract Details
Approval Date
10/21/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/21/2024
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