| Details | Grant Number | Update | Change Request | 1 NU62PS924550-01-00 | 6 NU62PS924818-01-01 | 4/25/2025 11:01 AM |
| Details | NOFO Number | Update | Change Request | PS18-1802 | PS24-0047 | 4/25/2025 11:01 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Patel, Rishi
President & CEO
CAN Community Health, Inc.
9413660461-11127 | Patel, Rishi
President & CEO
CAN Community Health, Inc.
9413004440-11127 | 1/28/2025 7:30 PM |
| Addresses | Shipping Address | Update | Change Request | CAN Community Health Pharmacy of Ft. Lauderdale
4101 NW 3rd Court
Ste 9
Plantation, FL 33317 | CAN Community Health Pharmacy of Ft. Lauderdale
4101 NW 3rd Court
Medical Plaza
Ste 9
Plantation, FL 33317 | 1/28/2025 9:38 AM |
| Details | Entity Subname | Update | Change Request | AZ Suite 2 | | 1/27/2025 7:33 AM |
| Addresses | Billing Address | Update | Group Change Request | CAN Community Health, Inc.
4440 Fruitville Rd
SARASOTA, FL 34232 | CAN Community Health, Inc.
2105 N. Nebraska Ave.
Tampa, FL 33602 | 6/20/2024 3:06 PM |
| Details | Last Recertification Date | Update | Recertification | 5/17/2023 10:53:34 AM | 5/27/2024 8:03:43 PM | 5/27/2024 8:03 PM |
| Addresses | Shipping Address | Update | Change Request | Tampa Family Pharmacy
2919 W Swann Ave.
Ste 101
Tampa, FL 33609 | Tampa Family Pharmacy
12470 Telecom Dr
Ste 110W
Temple Terrace, FL 33637 | 12/11/2023 1:03 PM |
| Addresses | Main Address | Update | Change Request |
4350 N 19th Avenue
Suite 2
Phoenix, AZ 85015 |
4244 N. 19th Avenue
Phoenix, AZ 85015 | 10/30/2023 1:48 PM |
| Addresses | Shipping Address | Update | Change Request | JTJ Medical Supply Inc., d/b/a Mail-Meds Clinical Pharmacy
4350 N 19th Ave.
Ste 2
Phoenix, AZ 85015 | JTJ Medical Supply Inc., d/b/a Mail-Meds Clinical Pharmacy
4244 N. 19th Avenue
Phoenix, AZ 85015 | 10/30/2023 1:48 PM |
| Details | Last Recertification Date | Update | Recertification | 6/5/2022 8:41:42 PM | 5/17/2023 10:53:34 AM | 5/17/2023 10:53 AM |
| Addresses | Shipping Address | Insert | Change Request | | JTJ Medical Supply Inc., d/b/a Mail-Meds Clinical Pharmacy
4350 N 19th Ave.
Ste 2
Phoenix, AZ 85015 | 9/22/2022 11:02 AM |
| Addresses | Shipping Address | Insert | Change Request | | JTJ Medical Supply Inc., d/b/a Mail-Meds Clinical Pharmacy
2331 W Royal Palm Rd.
Suite E
Phoenix, AZ 85021 | 7/22/2022 8:16 AM |
| Addresses | Shipping Address | Insert | Change Request | | Tampa Family Pharmacy
2919 W Swann Ave.
Ste 101
Tampa, FL 33609 | 7/22/2022 8:16 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Patel, Rishi
Interim President & CEO
CAN Community Health, Inc.
9413660461-11127 | Patel, Rishi
President & CEO
CAN Community Health, Inc.
9413660461-11127 | 7/5/2022 4:02 PM |
| Details | Last Recertification Date | Update | Recertification | 6/4/2021 3:12:04 PM | 6/5/2022 8:41:42 PM | 6/5/2022 8:41 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Joshi, Hemali
VP Enterprise Systems & Pharmacy Analytics
CAN Community Health, Inc.
9413004440-10161 | Joshi, Hemali
SVP, Chief Data Officer
CAN Community Health, Inc.
9413004440-10161 | 4/8/2022 1:34 PM |
| Addresses | Shipping Address | Insert | Group Change Request | | CAN Community Health Pharmacy of Arlington
603 Matlock Centre Cir
Arlington, TX 76015 | 10/13/2021 8:27 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Joshi, Hemali
VP Quality, Analytics & Pharmacy Operations
CAN Community Health, Inc.
9413004440-10161 | Joshi, Hemali
VP Enterprise Systems & Pharmacy Analytics
CAN Community Health, Inc.
9413004440-10161 | 10/6/2021 12:58 PM |
| Contacts | Authorizing Official | Update | Change Request | Carlisle, Richard E.
President & CEO
CAN Community Health, Inc.
9413660134-11111 | Patel, Rishi
Interim President & CEO
CAN Community Health, Inc.
9413660461-11127 | 6/23/2021 12:53 PM |
| Contacts | Primary Contact | Update | Change Request | Patel, Rishi
Interim President & CEO
CAN Community Health, Inc.
9413660461-11127 | Joshi, Hemali
VP Quality, Analytics & Pharmacy Operations
CAN Community Health, Inc.
9413004440-10161 | 6/23/2021 12:53 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Patel, Rishi
Executive Vice President & Chief Operating Officer
CAN Community Health, Inc.
9413660461-11127 | Patel, Rishi
Interim President & CEO
CAN Community Health, Inc.
9413660461-11127 | 6/21/2021 12:48 PM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | | 7/16/2019 12:00:00 AM | 6/4/2021 3:12 PM |
| Details | Last Recertification Date | Update | Recertification | 5/29/2020 3:34:14 PM | 6/4/2021 3:12:04 PM | 6/4/2021 3:12 PM |
| Details | NOFO Number | Update | Recertification | | PS18-1802 | 6/4/2021 3:12 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Patel, Rishi
Senior Vice President of Pharmacy Services
CAN Community Health, Inc.
9413660461-11127 | Patel, Rishi
Executive Vice President & Chief Operating Officer
CAN Community Health, Inc.
9413660461-11127 | 10/1/2020 3:09 PM |
| Addresses | Shipping Address | Insert | Change Request | | CAN Community Health Pharmacy of Clearwater
2349 Sunset Point Road
Ste 404
Clearwater, FL 33765 | 9/23/2020 3:36 PM |
| Addresses | Shipping Address | Insert | Change Request | | CAN Community Health Pharmacy of Jacksonville
4615 Philips Hwy
Ste 3
Jacksonville, FL 32207 | 9/23/2020 3:36 PM |
| Addresses | Shipping Address | Insert | Change Request | | CAN Community Health Pharmacy of Ft. Lauderdale
4101 NW 3rd Court
Ste 9
Plantation, FL 33317 | 9/23/2020 3:36 PM |
| Details | Last Recertification Date | Update | Recertification | | 5/29/2020 3:34:14 PM | 5/29/2020 3:34 PM |
| Details | State | Update | | Approved | Active | 1/1/2020 12:04 AM |
| Contacts | Signed By | Insert | New Registration | | Carlisle, Richard E.
President & CEO
CAN Community Health, Inc.
9413660134-11111 | 11/6/2019 2:06 PM |
| Details | 340B ID | Update | New Registration | | STD850151 | 11/6/2019 2:06 PM |
| Dates | Participating Approval Date | Update | New Registration | | 11/6/2019 2:06:14 PM | 11/6/2019 2:06 PM |
| Details | State | Update | New Registration | Pending | Approved | 11/6/2019 2:06 PM |
| Dates | Signed By Date | Update | New Registration | | 10/15/2019 7:51:39 PM | 11/6/2019 2:06 PM |
| Dates | Start Date | Update | New Registration | | 1/1/2020 12:00:00 AM | 11/6/2019 2:06 PM |
| Addresses | Main Address | Insert | New Registration | |
4350 N 19th Avenue
Suite 2
Phoenix, AZ 85015 | 10/14/2019 9:37 PM |
| Addresses | Billing Address | Insert | New Registration | | CAN Community Health, Inc.
4440 Fruitville Rd
SARASOTA, FL 34232 | 10/14/2019 9:37 PM |
| Details | Nature Of Support | Insert | New Registration | | Direct Funding (dollars received from CDC or an intermediate organization) | 10/14/2019 9:37 PM |
| Contacts | Primary Contact | Insert | New Registration | | Patel, Rishi
Senior Vice President of Pharmacy Services
CAN Community Health, Inc.
9413660461-11127 | 10/14/2019 9:37 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Carlisle, Richard E.
President & CEO
CAN Community Health, Inc.
9413660134-11111 | 10/14/2019 9:37 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Details | Grant Number | Insert | New Registration | | 1 NU62PS924550-01-00 | 10/14/2019 9:37 PM |
| Details | 340B ID | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Details | Entity Name | Insert | New Registration | | CAN Community Health, Inc | 10/14/2019 9:37 PM |
| Details | Program Code | Insert | New Registration | | STD | 10/14/2019 9:37 PM |
| Details | Entity Subname | Insert | New Registration | | AZ Suite 2 | 10/14/2019 9:37 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Details | State | Insert | New Registration | | Pending | 10/14/2019 9:37 PM |
| Dates | Registration Date | Insert | New Registration | | 10/14/2019 9:37:19 PM | 10/14/2019 9:37 PM |
| Dates | Signed By Date | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Dates | Start Date | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Terminations | Termination Date | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/14/2019 9:37 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/14/2019 9:37 PM |