Contract Pharmacy Details

WALGREEN CO.
STD336141 CAN Community Health, Inc.

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

5/27/2024

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

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