Contract Pharmacy Details

PUBLIX SUPER MARKETS, INC.
RWII33605 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Ybor

Type

Ryan White Part B

340B ID

RWII33605

Entity Address

2105 N Nebraska Ave
Tampa, FL 33602

Grant Number

X07HA00057

Participating Start Date

7/1/2014

Last Recertification Date

2/25/2022

Entity Termination Date

10/1/2022

Pharmacy Details

Pharmacy Name

PUBLIX SUPER MARKETS, INC.

Pharmacy Address

PUBLIX COMPOUNDING PHARMACY #3212
2424 ORLANDO CENTRAL PKWY STE 200
ORLANDO, FL 32809

Pharmacy Comments

Contract Details

Approval Date

4/19/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/5/2020
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

Publix
Fred Ottolino, VP of Pharmacy Operations
(863) 688-1188 Ext: 52352

Signed By Date

4/19/2017

340B Drug Pricing Program Database