Contract Pharmacy Details

CRESCENT HEALTHCARE, INC.
RWII32117 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Daytona

Type

Ryan White Part B

340B ID

RWII32117

Entity Address

1125 N. Nova Rd.
Daytona Beach, FL 32117

Grant Number

X07HA00057

Participating Start Date

7/1/2014

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

CRESCENT HEALTHCARE, INC.

Pharmacy Address

1352 W. 15TH ST.
SUITE 8
PANAMA CITY, FL 32401-7411

Pharmacy Comments

Contract Details

Approval Date

4/15/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/15/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996

Signed By Date

4/15/2016

340B Drug Pricing Program Database