Contract Pharmacy Details

URBAN SPECIALTY PHARMACY, LLC
RWII33605 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Ybor

Type

Ryan White Part B

340B ID

RWII33605

Entity Address

2105 N Nebraska Ave
Tampa, FL 33602

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

URBAN SPECIALTY PHARMACY, LLC

Pharmacy Address

1617 34TH ST S STE A
ST PETERSBURG, FL 33711-2855

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

Urban Specialty Pharmacy
Paresh Shukla, PIC
(813) 928-4382

Signed By Date

1/22/2019

340B Drug Pricing Program Database