Contract Pharmacy Details

WALGREEN CO.
RWII33713 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Metro

Type

Ryan White Part B

340B ID

RWII33713

Entity Address

3251 3rd Avenue North
Suite 125
St. Petersburg, FL 33713

Grant Number

X07HA00057

Participating Start Date

7/1/2014

Last Recertification Date

2/25/2022

Entity Termination Date

10/1/2022

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02230
5420 DR MARTIN LUTHER KING JR ST N
ST PETERSBURG, FL 33703

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
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

7/15/2020

340B Drug Pricing Program Database