Contract Pharmacy Details

GENOA HEALTHCARE LLC
STD336141 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Habana

Type

Sexually Transmitted Diseases

340B ID

STD336141

Entity Address

4729 N Habana Ave
Tampa, FL 33614

Grant Number

1 NH25PS005131-01-00

Participating Start Date

4/1/2016

Last Recertification Date

6/3/2025

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

6075 BATHEY LANE, SUITE D-5
NAPLES, FL 34116

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/15/2021

340B Drug Pricing Program Database