340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HOLIDAY CVS, L.L.C.
DSH100142 JACKSON HOSPITAL
Print
Covered Entity Details
Entity Name
JACKSON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100142
Entity Address
4250 HOSPITAL DRIVE
MARIANNA, FL 32446
Medicare Provider Number
100142
Participating Start Date
4/1/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05167
12 DECATUR ST
CHATTAHOOCHEE, FL 32324
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/15/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LARRY MEESE, CEO
(850) 718-2622
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
7/15/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session