Contract Pharmacy Details

HOLIDAY CVS, L.L.C.
RWII327921F Hope and Help Center of Central Florida, Inc.

Covered Entity Details

Entity Name

Hope and Help Center of Central Florida, Inc.

Subdivision Name

Diversity Health Center of Tampa Bay

Type

Ryan White Part B

340B ID

RWII327921F

Entity Address

4302 N. Habana Ave.
Suite 200
Tampa, FL 33607-6368

Grant Number

X07HA00057

Participating Start Date

4/1/2018

Last Recertification Date

Entity Termination Date

7/1/2018

Pharmacy Details

Pharmacy Name

HOLIDAY CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05207
2725 N MACDILL AVE
TAMPA, FL 33607

Pharmacy Comments

Contract Details

Approval Date

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lisa Barr, Executive Director
(407) 645-2577 Ext: 121

Contract Pharmacy Representative

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

Signed By Date

4/16/2018

340B Drug Pricing Program Database