Contract Pharmacy Details

EXPRESS SCRIPTS PHARMACY, INC.
STD850153 CAN Community Health, Inc.

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

5/28/2025

Pharmacy Details

Pharmacy Name

EXPRESS SCRIPTS PHARMACY, INC.

Pharmacy Address

DBA EXPRESS SCRIPTS
2040 ROUTE 130 NORTH
BURLINGTON, NJ 08016

Pharmacy Comments

Contract Details

Approval Date

4/17/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Express Scripts
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

4/17/2020

340B Drug Pricing Program Database