Contract Pharmacy Details

WALGREEN CO.
RWII33511 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII33511

Entity Address

214 Morrison Road
Suite 104
Brandon, FL 33511

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 # 05451
315 W. PLATT STREET
TAMPA, FL 33606

Pharmacy Comments

Contract Details

Approval Date

4/8/2016

Contract Begin Date

7/1/2016

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

4/8/2016

340B Drug Pricing Program Database