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VOLEL PRFSNL PHRMST ASSOC
RWII342371C CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII342371C
Entity Address
4729 N Habana Ave
Tampa, FL 33614
Grant Number
X07HA00057
Participating Start Date
4/1/2016
Last Recertification Date
2/19/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
VOLEL PRFSNL PHRMST ASSOC
Pharmacy Address
PHARMACYONEPRO SPCLTY CR PHMCY
65 3RD ST NW
SUITE 59
WINTER HAVEN, FL 33881
Pharmacy Comments
Contract Details
Approval Date
7/15/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111
Contract Pharmacy Representative
Pharmacy One Pro
Paul Volel, Jr., CEO/Owner
(863) 401-9300
Signed By Date
7/15/2018
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