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VISTA MEDICAL GROUP LLC
STD335111 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
Sexually Transmitted Diseases
340B ID
STD335111
Entity Address
1218 Millennium Parkway
Brandon, FL 33511
Grant Number
5 NU65PS004814-02-00
Participating Start Date
7/1/2016
Last Recertification Date
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
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