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PRIDE PHARMACY, LLC
STD333341 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Dixie Hwy
Type
Sexually Transmitted Diseases
340B ID
STD333341
Entity Address
5333 N. Dixie Hwy
Suite 110
Fort Lauderdale, FL 33334
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2018
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
PRIDE PHARMACY, LLC
Pharmacy Address
MIDLAND PHARMACY
1421 E OAKLAND PARK BLVD
STE 100
OAKLAND PARK, FL 33334
Pharmacy Comments
Contract Details
Approval Date
10/24/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2025
Ownership change
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0461 Ext: 11111
Contract Pharmacy Representative
Midland Medical
Michael Supino, Managing Partner
(479) 366-7893
Signed By Date
10/16/2017
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