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JTJ MEDICAL SUPPLY, INC
STD235102 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Fort Tar
Type
Sexually Transmitted Diseases
340B ID
STD235102
Entity Address
1001 Monticello Ave
Suite 100
Norfolk, VA 23510
Grant Number
NH25PS005137
Participating Start Date
4/1/2022
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
6315 N CENTER DR STE 100
NORFOLK, VA 23502
Pharmacy Comments
Contract Details
Approval Date
2/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2025
Ownership change
Contacts
Covered Entity Signing Official
Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
1/19/2022
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