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PUBLIX SUPER MARKETS, INC.
STD33614 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
North Dale Mabry
Type
Sexually Transmitted Diseases
340B ID
STD33614
Entity Address
6919 North Dale Mabry, Suite 300
Tampa, FL 33614
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2016
Last Recertification Date
5/17/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX COMPOUNDING PHARMACY #3212
2424 ORLANDO CENTRAL PKWY STE 200
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
4/19/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2020
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
Publix
Fred Ottolino, VP of Pharmacy Operations
(863) 688-1188 Ext: 52352
Signed By Date
4/19/2017
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