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PUBLIX SUPER MARKETS
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
PUBLIX SUPER MARKETS
Pharmacy Address
PUBLIX PHARMACY #0685
5450 EAST BUSCH BLVD
TEMPLE TERRACE, FL 33617
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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