Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
RWII235101 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Fort Tar

Type

Ryan White Part B

340B ID

RWII235101

Entity Address

1001 Monticello Ave
Suite 100
Norfolk, VA 23510

Grant Number

X07HA00009

Participating Start Date

7/1/2019

Last Recertification Date

2/26/2023

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188

Pharmacy Comments

Contract Details

Approval Date

4/17/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/17/2020

340B Drug Pricing Program Database