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PUBLIX SUPER MARKETS, INC.
CH043823Q BREVARD HEALTH ALLIANCE INC., THE
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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
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #1398
5380 STADIUM PARKWAY, SUITE 100
ROCKLEDGE, FL 32955
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Austin Helton, CEO
(321) 241-6868
Contract Pharmacy Representative
Publix
Kimberly Bone, Manager of Managed Care, Pharmacy Operations
(863) 688-1188 Ext: 52364
Signed By Date
4/15/2019
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