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PUBLIX PHARMACY #1187
STD327501 26Health, Inc.
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Covered Entity Details
Entity Name
26Health, Inc.
Subdivision Name
West Orange Nephrology, LLC
Type
Sexually Transmitted Diseases
340B ID
STD327501
Entity Address
6909 Old Hwy 441
223
Mount Dora, FL 32750
Grant Number
1H25PS004342-02
Participating Start Date
1/1/2019
Last Recertification Date
5/4/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
PUBLIX PHARMACY #1187
Pharmacy Address
2783 ELKCAM BLVD
DELTONA, FL 32738
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Baker-Hargrove, President/Co-CEO
(321) 800-2922
Contract Pharmacy Representative
Publix
Dain Rusk, Vice President
(863) 688-1188
Signed By Date
7/15/2019
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