| Details | Last Recertification Date | Update | Recertification | 5/27/2024 8:00:52 PM | 5/28/2025 1:42:28 PM | 5/28/2025 1:42 PM |
| 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 |
| Contacts | Signed By | 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 9:43 AM |
| Addresses | Billing Address | Update | Group Change Request | CAN Community Health, Inc.
4440 Fruitville Road
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 10:55:21 AM | 5/27/2024 8:00:52 PM | 5/27/2024 8:00 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 10:46 AM |
| Addresses | Shipping Address | Insert | Change Request | | JTJ Medical Supply Inc., d/b/a Mail-Meds Clinical Pharmacy
8390 N Palafox St
Pensacola, FL 32534-3735 | 7/25/2023 8:54 AM |
| Details | Last Recertification Date | Update | Recertification | 6/5/2022 8:44:20 PM | 5/17/2023 10:55:21 AM | 5/17/2023 10:55 AM |
| Addresses | Shipping Address | Insert | Change Request | | JTJ Medical Supply Inc., d/b/a Mail-Meds Clinical Pharmacy
2692 Oak Ridge Ct
Fort Myers, FL 33901 | 7/20/2022 7:26 AM |
| Addresses | Shipping Address | Insert | Change Request | | Tampa Family Pharmacy
2919 W Swann Ave.
Ste 101
Tampa, FL 33609 | 7/20/2022 7:26 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 |
| Contacts | Signed By | 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 | | 6/5/2022 8:44:20 PM | 6/5/2022 8:44 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 |
| Details | State | Update | | Approved | Active | 4/1/2022 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Patel, Rishi
Interim President & CEO
CAN Community Health, Inc.
9413660461-11127 | 2/11/2022 9:10 AM |
| Details | 340B ID | Update | New Registration | | STD325471 | 2/11/2022 9:10 AM |
| Dates | Participating Approval Date | Update | New Registration | | 2/11/2022 9:10:50 AM | 2/11/2022 9:10 AM |
| Details | State | Update | New Registration | Pending | Approved | 2/11/2022 9:10 AM |
| Dates | Signed By Date | Update | New Registration | | 1/13/2022 10:57:45 AM | 2/11/2022 9:10 AM |
| Dates | Start Date | Update | New Registration | | 4/1/2022 12:00:00 AM | 2/11/2022 9:10 AM |
| Addresses | Main Address | Insert | New Registration | |
917 Mar Walt Drive
Fort Walton Beach, FL 32547 | 1/12/2022 9:28 PM |
| Addresses | Billing Address | Insert | New Registration | | CAN Community Health, Inc.
4440 Fruitville Road
Sarasota, FL 34232 | 1/12/2022 9:28 PM |
| Addresses | Shipping Address | Insert | New Registration | | CAN Community Health Pharmacy of Clearwater
2349 Sunset Point Road
Ste 404
Clearwater, FL 33765 | 1/12/2022 9:28 PM |
| Addresses | Shipping Address | Insert | New Registration | | CAN Community Health Pharmacy of Jacksonville
4615 Philips Hwy
Ste 3
Jacksonville, FL 32207 | 1/12/2022 9:28 PM |
| Addresses | Shipping Address | Insert | New Registration | | CAN Community Health Pharmacy of Ft. Lauderdale
4101 NW 3rd Court
Ste 9
Plantation, FL 33317 | 1/12/2022 9:28 PM |
| Addresses | Shipping Address | Insert | New Registration | | CAN Community Health Pharmacy of Arlington
603 Matlock Centre Cir
Arlington, TX 76015 | 1/12/2022 9:28 PM |
| Details | Nature of Support: In Kind Support Description | Insert | New Registration | | Educational Materials | 1/12/2022 9:28 PM |
| Details | Nature Of Support | Insert | New Registration | | In-Kind products or services (see note below; must have been purchased with section 318 funds) | 1/12/2022 9:28 PM |
| Details | Nature of Support: Support Received From Date | Insert | New Registration | | 7/1/2021 12:00:00 AM | 1/12/2022 9:28 PM |
| Details | Nature of Support: Support Received To Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Patel, Rishi
Interim President & CEO
CAN Community Health, Inc.
9413660461-11127 | 1/12/2022 9:28 PM |
| Contacts | Primary Contact | Insert | New Registration | | Joshi, Hemali
VP Enterprise Systems & Pharmacy Analytics
CAN Community Health, Inc.
9413004440-10161 | 1/12/2022 9:28 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | Grant Number | Insert | New Registration | | 1 NH25PS005131-01-00 | 1/12/2022 9:28 PM |
| Details | 340B ID | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | Entity Name | Insert | New Registration | | CAN Community Health, Inc. | 1/12/2022 9:28 PM |
| Details | NOFO Number | Insert | New Registration | | PS19-1901 | 1/12/2022 9:28 PM |
| Details | Program Code | Insert | New Registration | | STD | 1/12/2022 9:28 PM |
| Details | Entity Subname | Insert | New Registration | | Emerald Coast | 1/12/2022 9:28 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Details | State | Insert | New Registration | | Pending | 1/12/2022 9:28 PM |
| Dates | Registration Date | Insert | New Registration | | 1/12/2022 9:28:23 PM | 1/12/2022 9:28 PM |
| Dates | Signed By Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Dates | Start Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Terminations | Termination Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 1/12/2022 9:28 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 1/12/2022 9:28 PM |