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WALGREEN CO.
RWI33316E CAN Community Health, Inc
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Covered Entity Details
Entity Name
CAN Community Health, Inc
Subdivision Name
Ybor
Type
Ryan White Part A
340B ID
RWI33316E
Entity Address
2105 N Nebraska Ave
Tampa, FL 33602
Grant Number
H89HA00024
Participating Start Date
10/1/2024
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05576
7925 GUNN HIGHWAY
TAMPA, FL 33626
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
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
4/15/2021
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