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WOODWARD DETROIT CVS, L.L.C.
RWII235101 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Fort Tar
Type
Ryan White Part B
340B ID
RWII235101
Entity Address
1001 Monticello Ave
Suite 100
Norfolk, VA 23510
Grant Number
X07HA00009
Participating Start Date
7/1/2019
Last Recertification Date
2/26/2023
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08051
22000 ECORSE RD.
TAYLOR, MI 48180
Pharmacy Comments
Contract Details
Approval Date
1/12/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2022
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