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TAMPA FAMILY PHARMACY
RW4248350 CAN Community Health, Inc
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Covered Entity Details
Entity Name
CAN Community Health, Inc
Subdivision Name
Ybor
Type
Ryan White Part D
340B ID
RW4248350
Entity Address
2105 N Nebraska Ave
Tampa, FL 33602
Grant Number
H12HA24835
Participating Start Date
10/1/2020
Last Recertification Date
2/25/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
TAMPA FAMILY PHARMACY
Pharmacy Address
12470 TELECOM DR STE 110W
TEMPLE TERRACE, FL 33637
Pharmacy Comments
Contract Details
Approval Date
8/28/2020
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
Tampa Family Pharmacy
Hansil Kalaria, Director of Operations
(813) 868-5710
Signed By Date
7/15/2020
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