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JTJ MEDICAL SUPPLY, INC
STD336141 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Habana
Type
Sexually Transmitted Diseases
340B ID
STD336141
Entity Address
4729 N Habana Ave
Tampa, FL 33614
Grant Number
1 NH25PS005131-01-00
Participating Start Date
4/1/2016
Last Recertification Date
6/3/2025
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL MEDS CLINICAL PHARMACY
2692 OAK RIDGE CT
FORT MYERS, FL 33901
Pharmacy Comments
Contract Details
Approval Date
3/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2025
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
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