Contract Pharmacy Details

PUBLIX SUPER MARKETS, 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

PUBLIX SUPER MARKETS, INC.

Pharmacy Address

PUBLIX PHARMACY #0582
2724 W HILLSBOROUGH AVE
TAMPA, FL 33614

Pharmacy Comments

Contract Details

Approval Date

4/19/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111

Contract Pharmacy Representative

Publix
Fred Ottolino, VP of Pharmacy Operations
(863) 688-1188 Ext: 52352

Signed By Date

4/19/2017

340B Drug Pricing Program Database