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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06732
2102 W BAKER STREET
PLANT CITY, FL 33563-1643
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2017
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