Contract Pharmacy Details

COMMCARE PHARMACY-WPB, LLC
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

COMMCARE PHARMACY-WPB, LLC

Pharmacy Address

1689 FORUM PLACE
WEST PALM BEACH, FL 33401

Pharmacy Comments

Contract Details

Approval Date

7/14/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/21/2016
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Commcare Pharmacy
Avani Patel, Client Relations Manager
(954) 284-2358

Signed By Date

7/14/2016

340B Drug Pricing Program Database