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PUBLIX SUPER MARKETS, INC.
STD33629 Comprehensive Care Center, Inc. dba Community AIDS Network
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Covered Entity Details
Entity Name
Comprehensive Care Center, Inc. dba Community AIDS Network
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33629
Entity Address
3317 W Gandy Blvd
Tampa, FL 33611
Grant Number
5 NU65PS004814-02
Participating Start Date
1/1/2016
Last Recertification Date
5/16/2017
Entity Termination Date
10/1/2017
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
10/1/2017
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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