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VRX 1 LLC
RWI23510 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Fort Tar
Type
Ryan White Part A
340B ID
RWI23510
Entity Address
6315 N Center Dr
Suite 100
Norfolk, VA 23502
Grant Number
H89HA00053
Participating Start Date
10/1/2022
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
VRX 1 LLC
Pharmacy Address
D/B/A HAGUE PHARMACY
400 GRESHAM DR # 104
NORFOLK, VA 23507
Pharmacy Comments
Contract Details
Approval Date
8/6/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111
Contract Pharmacy Representative
Hague Pharmacy
Vishrut Patel, Manager
(757) 622-0222
Signed By Date
7/12/2018
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