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PUBLIX SUPER MARKETS INC
CH043823B BREVARD HEALTH ALLIANCE INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA PALM BAY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH043823B
Entity Address
5270 Babcock St NE STE 1
Palm Bay, FL 32905-4616
Grant Number
H80CS04213
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS INC
Pharmacy Address
PUBLIX PHARMACY #0779
3450 BAYSIDE LAKES BLVD., S.E.
PALM BAY, FL 32909
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
12/9/2020
CE terminated due to audit finding
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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