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VISTA MEDICAL GROUP LLC
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
VISTA MEDICAL GROUP LLC
Pharmacy Address
MEDICASCRIPTS PHARMACY
15511 N. FLORIDA AVE
TAMPA, FL 33613
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2018
Ownership change
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111
Contract Pharmacy Representative
Bhavik Patel, owner
(813) 968-0520
Signed By Date
7/14/2016
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