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HOLIDAY CVS, L.L.C.
DSH100075 ST JOSEPH'S HOSPITAL
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Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100075
Entity Address
3001 WEST DR. M L KING JR BLVD
TAMPA, FL 33607
Medicare Provider Number
100075
Participating Start Date
4/1/2003
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04701
6701 N. DALE MABRY HWY.
TAMPA, FL 33614
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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