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JTJ MEDICAL SUPPLY, INC
STD32801 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Crew
Type
Sexually Transmitted Diseases
340B ID
STD32801
Entity Address
8601 Commodity Circle
Suite 106
Orlando, FL 32819
Grant Number
1 NH25PS005131-01-00
Participating Start Date
4/1/2019
Last Recertification Date
5/29/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
1301 W COLONIAL DR STE 102
ORLANDO, FL 32804
Pharmacy Comments
Contract Details
Approval Date
2/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
1/22/2019
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