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WINN-DIXIE STORES
CH043823H BREVARD HEALTH ALLIANCE INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA Barton Commons
Type
HRSA-Funded Health Center
340B ID
CH043823H
Entity Address
220 Barton Blvd
Rockledge, FL 32955-2742
Grant Number
H80CS04213
Participating Start Date
7/1/2006
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WINN-DIXIE STORES
Pharmacy Address
DBA WINN DIXIE PHARMACY #2367
7960 US HIGHWAY #1-UNIT 1
MICCO, FL 32976
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/18/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Richard Austin Helton, CEO
(321) 241-6868
Contract Pharmacy Representative
Winn Dixie
David Chism, Senior Director
(904) 370-6455
Signed By Date
4/11/2019
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