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TAMPA FAMILY PHARMACY
STD342871 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
North Port
Type
Sexually Transmitted Diseases
340B ID
STD342871
Entity Address
14243 Tamiami Trail
North Port, FL 34287
Grant Number
NU62PS924532
Participating Start Date
4/5/2019
Last Recertification Date
5/28/2025
Pharmacy Details
Pharmacy Name
TAMPA FAMILY PHARMACY
Pharmacy Address
12470 TELECOM DR STE 110W
TEMPLE TERRACE, FL 33637
Pharmacy Comments
Contract Details
Approval Date
4/5/2019
Contract Begin Date
4/8/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2025
Ownership change
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
TFP Wellness Systems
Haley Miller, President
(813) 871-5161
Signed By Date
4/5/2019
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