Contract Pharmacy Details

PUBLIX SUPER MARKETS, INC.
CH04550P PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Covered Entity Details

Entity Name

PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Subdivision Name

Premier Community HealthCare Group, Inc. - Dental Clinic #4

Type

HRSA-Funded Health Center

340B ID

CH04550P

Entity Address

10841 LITTLE RD
NEW PORTY RICHEY, FL 34654-2513

Grant Number

H80CS00101

Participating Start Date

1/1/2021

Last Recertification Date

2/14/2023

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

PUBLIX SUPER MARKETS, INC.

Pharmacy Address

PUBLIX PHARMACY #1496
11830 US HWY 301
DADE CITY, FL 33525

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/23/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Joseph Resnick, CEO
(352) 518-2000 Ext: 9000

Contract Pharmacy Representative

Publix Super Markets
Dain Rusk, Vice President Pharmacy
(863) 616-5846

Signed By Date

10/15/2020

340B Drug Pricing Program Database