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PUBLIX SUPER MARKETS
CH04550P PREMIER COMMUNITY HEALTHCARE GROUP, INC.
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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
Pharmacy Address
PUBLIX PHARMACY #1245
7838 GALL BLVD
ZEPHYRHILLS, FL 33541-4370
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
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