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PUBLIX SUPER MARKETS, INC.
STD32763 26Health, Inc.
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Covered Entity Details
Entity Name
26Health, Inc.
Subdivision Name
Gastroenterology of Greater Orlando, LLC
Type
Sexually Transmitted Diseases
340B ID
STD32763
Entity Address
2884 Wellness Ave
402
Orange City, FL 32763
Grant Number
1H25PS004342-02
Participating Start Date
7/1/2019
Last Recertification Date
5/4/2020
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #1500
2431 S. WOODLAND BLVD
DELAND, FL 32720
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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