Contract Pharmacy Details

PUBLIX PHARMACY #0523
CH043823A BREVARD HEALTH ALLIANCE INC., THE

Covered Entity Details

Entity Name

BREVARD HEALTH ALLIANCE INC., THE

Subdivision Name

BHA Melbourne Clinic

Type

HRSA-Funded Health Center

340B ID

CH043823A

Entity Address

17 Silver Palm Avenue
Melbourne, FL 32901-3123

Grant Number

H80CS04213

Participating Start Date

4/1/2005

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

PUBLIX PHARMACY #0523

Pharmacy Address

7325 U.S. HIGHWAY 1 NORTH
COCOA, FL 32927

Pharmacy Comments

Contract Details

Approval Date

4/15/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

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

340B Drug Pricing Program Database