Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII32301 Big Bend Cares Inc.

Covered Entity Details

Entity Name

Big Bend Cares Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII32301

Entity Address

2201 South Monroe Street
Tallahassee, FL 32301

Grant Number

X07HA00057

Participating Start Date

7/1/2013

Last Recertification Date

2/4/2019

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03624
1208 W. JEFFERSON ST.
QUINCY, FL 32351

Pharmacy Comments

Contract Details

Approval Date

4/3/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Robert Renzi, CEO
(850) 656-2437 Ext: 240

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/3/2018

340B Drug Pricing Program Database