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WALGREEN CO.
STD33511 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Brandon
Type
Sexually Transmitted Diseases
340B ID
STD33511
Entity Address
214 Morrison Road, Suite 104
Brandon, FL 33511
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2016
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03145
1860 E. FOWLER AVE.
TAMPA, FL 33612
Pharmacy Comments
Contract Details
Approval Date
4/8/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
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
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