Contract Pharmacy Details

WINN-DIXIE STORES INC
CH043823Q BREVARD HEALTH ALLIANCE INC., THE

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 STORES INC

Pharmacy Address

WINN-DIXIE PHARMACY #2327
1535 N SINGLETON AVE
TITUSVILLE, FL 32796

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

10/24/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Richard Austin Helton, CEO
(321) 241-6868

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/11/2019

340B Drug Pricing Program Database