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HOLIDAY CVS, L.L.C.
DSH100009 University of Miami Hospital
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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 # 05125
735 NW 119TH ST
NORTH MIAMI, FL 33168
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
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
University of Miami Hospital and Clinics
Blanca Rivera, Associate Vice President, UHealth Pharmacy Services
(305) 689-5630
Signed By Date
10/10/2014
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