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MAXOR PHARMACIES
HV001230 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Arlington
Type
Ryan White Part C
340B ID
HV001230
Entity Address
601 Matlock Centre Circle
Arlington, TX 76015
Grant Number
H76HA00123
Participating Start Date
10/1/2020
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
MAXOR PHARMACIES
Pharmacy Address
1058 HERCULES AVE
HOUSTON, TX 77058
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
Maxor
Ben Kelly, Regional Manager (East Coast)
(407) 325-4021
Signed By Date
1/15/2021
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