Contract Pharmacy Details

WALGREEN CO.
STD322075 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Jacksonville

Type

Sexually Transmitted Diseases

340B ID

STD322075

Entity Address

4615 Philips Highway
Suite 3
Jacksonville, FL 32207

Grant Number

1 NH25PS005131-01-00

Participating Start Date

7/1/2016

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03930
11 UNIVERSITY BLVD N
JACKSONVILLE, FL 32211

Pharmacy Comments

Contract Details

Approval Date

7/19/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111

Contract Pharmacy Representative

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

Signed By Date

7/19/2018

340B Drug Pricing Program Database