Contract Pharmacy Details

WINN-DIXIE STORES
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

WINN-DIXIE STORES

Pharmacy Address

DBA WINN DIXIE PHARMACY #2367
7960 US HIGHWAY #1-UNIT 1
MICCO, FL 32976

Pharmacy Comments

Contract Details

Approval Date

7/18/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/18/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Richard Austin Helton, CEO
(321) 241-6868

Contract Pharmacy Representative

Winn Dixie
David Chism, Senior Director
(904) 370-6455

Signed By Date

7/18/2019

340B Drug Pricing Program Database