Contract Pharmacy Details

WALGREEN CO.
RWII33825 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII33825

Entity Address

3300 US 27 South
Avon Park, FL 33825

Grant Number

X07HA00057

Participating Start Date

10/1/2014

Last Recertification Date

2/20/2018

Entity Termination Date

1/1/2019

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05946
93 US HIGHWAY 27 S
AVON PARK, FL 33825

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

1/1/2019
Covered Entity Terminated

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