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SAMSON MERGER SUB, LLC
CH041750 SUNCOAST COMMUNITY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
SUNCOAST COMMUNITY HEALTH CENTERS, INC.
Subdivision Name
SUNCOAST COMMUNITY HEALTH CENTERS, INC.
Type
HRSA-Funded Health Center
340B ID
CH041750
Entity Address
820 15th ST SE
Ruskin, FL 33570
Grant Number
H80CS00541
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
SAMSON MERGER SUB, LLC
Pharmacy Address
WINN DIXIE #2454
750 MARTIN LUTHER KING BLVD WEST
SEFFNER, FL 33584
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/7/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bradley Herremans, CEO
(813) 653-6268
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
1/15/2021
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