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JTJ MEDICAL SUPPLY, INC
STD850153 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
AZ Suite 6
Type
Sexually Transmitted Diseases
340B ID
STD850153
Entity Address
4350 N 19th Avenue
Suite 6
Phoenix, AZ 85015
Grant Number
6 NU62PS924818-01-01
Participating Start Date
1/1/2020
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
2331 W ROYAL PALM RD
SUITE E
PHOENIX, AZ 85021-4940
Pharmacy Comments
Contract Details
Approval Date
4/7/2020
Contract Begin Date
4/7/2020
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
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
4/7/2020
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