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JTJ MEDICAL SUPPLY, INC.
RWII292011A CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Columbia
Type
Ryan White Part B
340B ID
RWII292011A
Entity Address
1911 Hampton St
Columbia, SC 29201
Grant Number
X07HA00038
Participating Start Date
7/1/2019
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC.
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
2200 S MONROE ST
SUITE 201
TALLAHASSEE, FL 32301-6303
Pharmacy Comments
Contract Details
Approval Date
6/28/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Business decision by covered entity and/or pharmacy
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
6/28/2019
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