Contract Pharmacy Details

WALGREEN CO.
RWII32117 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Daytona

Type

Ryan White Part B

340B ID

RWII32117

Entity Address

1125 N. Nova Rd.
Daytona Beach, FL 32117

Grant Number

X07HA00057

Participating Start Date

7/1/2014

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04261
1420 BEVILLE ROAD
DAYTONA BEACH, FL 32114-5622

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

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

Signed By Date

4/17/2020

340B Drug Pricing Program Database