340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WINN-DIXIE STORES, INC.
SCH100106-00 DOCTORS MEMORIAL
Print
Covered Entity Details
Entity Name
DOCTORS MEMORIAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH100106-00
Entity Address
333 BYRON BUTLER PARKWAY
PERRY, FL 32347
Medicare Provider Number
100106
Participating Start Date
10/1/2019
Last Recertification Date
8/23/2023
Entity Termination Date
11/16/2023
Pharmacy Details
Pharmacy Name
WINN-DIXIE STORES, INC.
Pharmacy Address
WINN-DIXIE PHARMACY #104
2057 S BYRON BULTER PKWY, SUITE 1
PERRY, FL 32348
Pharmacy Comments
Contract Details
Approval Date
1/3/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/25/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Thomas J. Stone, Chief Executive Officer
(850) 584-0886
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
1/3/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session