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HOLIDAY CVS, L.L.C.
CH040250 PROJECT HEALTH, INC.
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Covered Entity Details
Entity Name
PROJECT HEALTH, INC.
Subdivision Name
Langley Health Services Sumterville
Type
HRSA-Funded Health Center
340B ID
CH040250
Entity Address
1389 S Us 301
Sumterville, FL 33585-5143
Grant Number
H80CS00412
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03639
420 N MAIN ST
BUSHNELL, FL 33513
Pharmacy Comments
Contract Details
Approval Date
10/23/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Costantino, CFO
(352) 793-5900
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
10/23/2015
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