Contract Pharmacy Details

WALGREEN CO.
RWII34287 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

North Port

Type

Ryan White Part B

340B ID

RWII34287

Entity Address

14243 Tamiami Trail
North Port, FL 34287

Grant Number

X07HA00057

Participating Start Date

1/1/2014

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04700
4340 S. FLORIDA AVE.
LAKELAND, FL 33813

Pharmacy Comments

Contract Details

Approval Date

10/15/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/13/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/15/2015

340B Drug Pricing Program Database