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URBAN SPECIALTY PHARMACY, LLC
STD337131 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
St. Pete
Type
Sexually Transmitted Diseases
340B ID
STD337131
Entity Address
3251 3rd Ave. North, Suite 125
St. Petersburg, FL 33713
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2016
Last Recertification Date
5/29/2025
Pharmacy Details
Pharmacy Name
URBAN SPECIALTY PHARMACY, LLC
Pharmacy Address
1617 34TH ST S STE A
ST PETERSBURG, FL 33711-2855
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111
Contract Pharmacy Representative
Urban Specialty Pharmacy
Paresh Shukla, PIC
(813) 928-4382
Signed By Date
10/17/2016
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