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COMMCARE PHARMACY-FTL, LLC
STD342871 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
North Port
Type
Sexually Transmitted Diseases
340B ID
STD342871
Entity Address
14243 Tamiami Trail
North Port, FL 34287
Grant Number
NU62PS924532
Participating Start Date
4/5/2019
Last Recertification Date
5/28/2025
Pharmacy Details
Pharmacy Name
COMMCARE PHARMACY-FTL, LLC
Pharmacy Address
855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223
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
4/1/2019
Covered Entity Terminated
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
(561) 310-4324
Signed By Date
7/14/2016
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