Contract Pharmacy Details

VISTA MEDICAL GROUP LLC
RWII342371E Comprehensive Care Center, Inc dba Community AIDS Network

Covered Entity Details

Entity Name

Comprehensive Care Center, Inc dba Community AIDS Network

Subdivision Name

Type

Ryan White Part B

340B ID

RWII342371E

Entity Address

1218 Millennium Parkway
Brandon, FL 33511

Grant Number

X07HA00057

Participating Start Date

7/1/2016

Last Recertification Date

1/30/2017

Entity Termination Date

7/1/2017

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

7/1/2017

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

340B Drug Pricing Program Database