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JTJ MEDICAL SUPPLY, INC.
RWII342371K CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Pensacola
Type
Ryan White Part B
340B ID
RWII342371K
Entity Address
8390 N Palafox St.
Pensacola, FL 32534
Grant Number
X07HA00057
Participating Start Date
7/1/2020
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC.
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
2200 S MONROE ST
SUITE 201
TALLAHASSEE, FL 32301-6303
Pharmacy Comments
Contract Details
Approval Date
6/5/2020
Contract Begin Date
7/1/2020
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
5/29/2020
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