Contract Pharmacy Details

WALGREEN CO.
STD34652 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

NPR

Type

Sexually Transmitted Diseases

340B ID

STD34652

Entity Address

4758 Rowan Road
New Port Richey, FL 34653

Grant Number

1 NH25PS005131-01-00

Participating Start Date

10/1/2017

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07105
11010 BLOOMINGDALE AVENUE
RIVERVIEW, FL 33578

Pharmacy Comments

Contract Details

Approval Date

7/15/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/15/2018

340B Drug Pricing Program Database