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PUBLIX SUPER MARKETS, INC.
RWII342371E Comprehensive Care Center, Inc dba Community AIDS Network
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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
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
7/1/2017
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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