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PUBLIX SUPER MARKETS, INC.
STD322161 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD322161
Entity Address
6817 South Point Parkway, Suite 801
Jacksonville, FL 32216
Grant Number
NH25PS004342-04-01
Participating Start Date
1/1/2016
Last Recertification Date
5/16/2017
Entity Termination Date
7/1/2018
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
7/1/2018
Covered Entity Terminated
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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