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HOLIDAY CVS, L.L.C.
DSH100052 WINTER HAVEN HOSPITAL
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Covered Entity Details
Entity Name
WINTER HAVEN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100052
Entity Address
200 AVENUE F, NE
WINTER HAVEN, FL 33881
Medicare Provider Number
100052
Participating Start Date
1/1/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00176
970 CYPRESS GARDENS BLVD.
WINTER HAVEN, FL 33880
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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