Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH100067 ST. ANTHONYS HOSPITAL

Covered Entity Details

Entity Name

ST. ANTHONYS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100067

Entity Address

1200 7TH AVENUE NORTH
ST. PETERSBURG, FL 33705

Medicare Provider Number

100067

Participating Start Date

10/1/2020

Last Recertification Date

9/8/2023

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02759
845 4TH ST. NORTH
SAINT PETERSBURG, FL 33701

Pharmacy Comments

Contract Details

Approval Date

7/15/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2015

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

7/15/2015

340B Drug Pricing Program Database