Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
DSH100009 University of Miami Hospital

Covered Entity Details

Entity Name

University of Miami Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100009

Entity Address

1400 N.W. 12th Ave
Miami, FL 33136

Medicare Provider Number

100009

Participating Start Date

4/1/2013

Last Recertification Date

8/31/2016

Entity Termination Date

1/1/2018

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03672
13749 SW 152ND ST
MIAMI, FL 33177

Pharmacy Comments

Contract Details

Approval Date

7/17/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

David Zambrana, Chief Executive Officer
(305) 689-4515

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

7/17/2014

340B Drug Pricing Program Database