Contract Pharmacy Details

WALGREEN CO.
RW4248350 CAN Community Health, Inc

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

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

340B Drug Pricing Program Database