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HOLIDAY CVS, L.L.C.
STD327204 Home Of Grace INC
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Covered Entity Details
Entity Name
Home Of Grace INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD327204
Entity Address
665 Peachwood Drive
Suite 1
Deland, FL 32720
Grant Number
H25PS005131
Participating Start Date
1/4/2023
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03657
1250 PROVIDENCE BLVD
DELTONA, FL 32725
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adaobi Oguchi, President
(407) 402-6324
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2025
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