Contract Pharmacy Details

WALGREEN CO.
RWII342371G CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

New Port Richey

Type

Ryan White Part B

340B ID

RWII342371G

Entity Address

4747 US Highway 19
New Port Richey, FL 34652

Grant Number

X07HA00057

Participating Start Date

10/1/2017

Last Recertification Date

2/25/2022

Entity Termination Date

10/1/2022

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

Contract Termination Date
Termination Reason

10/1/2022
Covered Entity Terminated

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