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PUBLIX PHARMACY #0424
CH043823R BREVARD HEALTH ALLIANCE, INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE, INC., THE
Subdivision Name
BHA Evans Center Clinic
Type
HRSA-Funded Health Center
340B ID
CH043823R
Entity Address
1361 Florida Ave NE
STE 2
Palm Bay, FL 32905-2650
Grant Number
H80CS04213
Participating Start Date
4/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PUBLIX PHARMACY #0424
Pharmacy Address
1150 MALABAR RD SE
SUITE #120
PALM BAY, FL 32907
Pharmacy Comments
Contract Details
Approval Date
7/18/2019
Contract Begin Date
10/1/2019
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
7/18/2019
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