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PUBLIX SUPER MARKETS, INC.
RWII33713 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Metro
Type
Ryan White Part B
340B ID
RWII33713
Entity Address
3251 3rd Avenue North
Suite 125
St. Petersburg, FL 33713
Grant Number
X07HA00057
Participating Start Date
7/1/2014
Last Recertification Date
2/25/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #3220
620 10TH ST. N. SUITE 101
ST PETERSBURG, FL 33705
Pharmacy Comments
Contract Details
Approval Date
1/22/2019
Contract Begin Date
4/1/2019
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) 366-0134 Ext: 11111
Contract Pharmacy Representative
Publix
Fred Ottolino, VP of Pharmacy Operations
(863) 688-1188 Ext: 52352
Signed By Date
1/22/2019
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