Contract Pharmacy Details

COMMCARE PHARMACY-WPB, LLC
RWII33614 CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII33614

Entity Address

6919 N. Dale Mabry
Suite 300
Tampa, FL 33614

Grant Number

X07HA00057

Participating Start Date

1/1/2015

Last Recertification Date

2/20/2018

Entity Termination Date

1/1/2019

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