Contract Pharmacy Details

CRESCENT HEALTHCARE, INC.
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

6/3/2025

Pharmacy Details

Pharmacy Name

CRESCENT HEALTHCARE, INC.

Pharmacy Address

1352 W. 15TH ST.
SUITE 8
PANAMA CITY, FL 32401-7411

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

4/15/2021
Pharmacy closed

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

340B Drug Pricing Program Database