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OPTION CARE ENTERPRISES, INC.
RWII342371C CAN Community Health, Inc.
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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
OPTION CARE ENTERPRISES, INC.
Pharmacy Address
D/B/A OPTION CARE
6401 W WATERS AVE
TAMPA, FL 33634
Pharmacy Comments
Contract Details
Approval Date
4/26/2016
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
Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996
Signed By Date
4/26/2016
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