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HOLIDAY CVS, L.L.C.
DSH100067 ST. ANTHONYS HOSPITAL
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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 # 02873
2200 34TH STREET NORTH
SAINT PETERSBURG, FL 33713
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
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