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HOLIDAY CVS, L.L.C.
DSH100132 SOUTH FLORIDA BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
SOUTH FLORIDA BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100132
Entity Address
3202 N Park Rd
PLANT CITY, FL 33563
Medicare Provider Number
100132
Participating Start Date
1/1/2004
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05201
403 N ALEXANDER ST
PLANT CITY, FL 33563
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
4/14/2015
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