Contract Pharmacy Details

WALGREEN CO.
RWII342371C CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII342371C

Entity Address

4729 N Habana Ave
Tampa, FL 33614

Grant Number

X07HA00057

Participating Start Date

4/1/2016

Last Recertification Date

2/19/2018

Entity Termination Date

1/1/2019

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12673
2916 E. FLETCHER 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

Contract Termination Date
Termination Reason

1/1/2019
Covered Entity Terminated

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

340B Drug Pricing Program Database