340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WINN DIXIE PHARMACY #2230
CH043823Q BREVARD HEALTH ALLIANCE INC., THE
Print
Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA Port St. John
Type
HRSA-Funded Health Center
340B ID
CH043823Q
Entity Address
7227 N HIGHWAY 1
SUITE 300
COCOA, FL 32927-5020
Grant Number
H80CS04213
Participating Start Date
4/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY #2230
Pharmacy Address
190 MALABAR RD SW
PALM BAY, FL 32907
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
9/28/2023
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session