Contract Pharmacy Details

PUBLIX SUPER MARKETS, INC.
DSH100093 BAPTIST HOSPITAL

Covered Entity Details

Entity Name

BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100093

Entity Address

123 Baptist Way
PENSACOLA, FL 32503

Medicare Provider Number

100093

Participating Start Date

4/1/2009

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

PUBLIX SUPER MARKETS, INC.

Pharmacy Address

PUBLIX PHARMACY #1318
5998 MOBILE HWY
PENSACOLA, FL 32526

Pharmacy Comments

Contract Details

Approval Date

4/17/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Andrew L. Terry, Vice President Revenue Management
(850) 469-7643

Contract Pharmacy Representative

Publix
Kimberly Bone, Manager of Managed Care, Pharmacy Operations
(863) 688-1188 Ext: 52364

Signed By Date

4/17/2019

340B Drug Pricing Program Database