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PINE BROOK PHARMACY LLC.
CH04550E PREMIER COMMUNITY HEALTHCARE GROUP, INC.
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Covered Entity Details
Entity Name
PREMIER COMMUNITY HEALTHCARE GROUP, INC.
Subdivision Name
Dade City Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH04550E
Entity Address
14027 5TH STREET
DADE CITY, FL 33525
Grant Number
H80CS00101
Participating Start Date
4/1/1998
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
PINE BROOK PHARMACY LLC.
Pharmacy Address
14111 CORTEZ BLVD
BROOKSVILLE, FL 34613
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Resnick, CEO
(352) 518-2000 Ext: 9000
Contract Pharmacy Representative
Pinebrook Pharmacy
Gautam Thakkar, Owner
(813) 454-3500
Signed By Date
10/15/2020
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