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PUBLIX SUPER MARKETS, 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
5/27/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX COMPOUNDING PHARMACY #3212
2424 ORLANDO CENTRAL PKWY STE 200
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
4/19/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2020
Business decision by covered entity and/or pharmacy
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
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