Contract Pharmacy Details

AVELLA OF ORLANDO
STD85260 CAN Community Health, Inc

Covered Entity Details

Entity Name

CAN Community Health, Inc

Subdivision Name

Scottsdale

Type

Sexually Transmitted Diseases

340B ID

STD85260

Entity Address

15425 N Greenway Hayden Loop
Suite A300
Scottsdale, AZ 85260

Grant Number

6 NU62PS924818-01-01

Participating Start Date

1/1/2020

Last Recertification Date

5/27/2024

Pharmacy Details

Pharmacy Name

AVELLA OF ORLANDO

Pharmacy Address

100 TECHNOLOGY PARK STE 155
LAKE MARY, FL 32746-6205

Pharmacy Comments

Contract Details

Approval Date

11/6/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111

Contract Pharmacy Representative

Optum RX
Joseph Iovino, VP
(412) 445-4495

Signed By Date

10/15/2019

340B Drug Pricing Program Database