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WINN DIXIE STORE #30
CH042710 TRENTON MEDICAL CENTER
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Covered Entity Details
Entity Name
TRENTON MEDICAL CENTER
Subdivision Name
Palms Medical Group - Trenton
Type
HRSA-Funded Health Center
340B ID
CH042710
Entity Address
911 South Main street
Trenton, FL 32693
Grant Number
H80CS00691
Participating Start Date
10/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE STORE #30
Pharmacy Address
20303 N US HWY 441
HIGH SPRINGS, FL 32643
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2023
Ownership change
Contacts
Covered Entity Signing Official
Anita Rembert, CEO
(352) 463-4501
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
4/15/2020
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