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WINN DIXIE STORES, INC.
CAH101309-00 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101309-00
Entity Address
524 W Sagamore Ave
Clewiston, FL 33440
Medicare Provider Number
101309
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WINN DIXIE STORES, INC.
Pharmacy Address
WINN-DIXIE PHARMACY #721
960 SOUTH MAIN STREET
LABELLE, FL 33935
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Troy Eller, CFO
(863) 902-3082
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
7/7/2021
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