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WINN-DIXIE STORES, INC.
CH0413190 TREASURE COAST COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
TREASURE COAST COMMUNITY HEALTH INC
Subdivision Name
TREASURE COAST COMMUNITY HEALTH, INC. South County
Type
HRSA-Funded Health Center
340B ID
CH0413190
Entity Address
1545 9th St. SW
Vero Beach, FL 32962-4312
Grant Number
H80CS00187
Participating Start Date
7/1/2000
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WINN-DIXIE STORES, INC.
Pharmacy Address
WINN-DIXIE PHARMACY #2354
995 FELLSMERE RD., UNIT B
SEBASTIAN, FL 32958
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
VICKI L. SOULE, CEO
(772) 571-1986
Contract Pharmacy Representative
John Fegen, Vice President of Pharmacy
(904) 783-5020
Signed By Date
1/16/2014
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