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HOLIDAY CVS, L.L.C.
CH041700 COLLIER HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COLLIER HEALTH SERVICES, INC.
Subdivision Name
COLLIER HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH041700
Entity Address
1454 Madison Ave W
Immokalee, FL 34142-2200
Grant Number
H80CS00735
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03248
1102 N 15TH ST
IMMOKALEE, FL 34142
Pharmacy Comments
Contract Details
Approval Date
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Ellis, President/CEO
(239) 658-3158
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/14/2016
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