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PUBLIX SUPER MARKETS, INC
DSH100006 ORLANDO HEALTH
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Covered Entity Details
Entity Name
ORLANDO HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100006
Entity Address
52 W. Underwood St
ORLANDO, FL 32806
Medicare Provider Number
100006
Participating Start Date
4/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC
Pharmacy Address
PUBLIX PHARMACY #1092
3400 AVALON PARK EAST BLVD
ORLANDO, FL 32828
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BERNADETTE SPONG, CFO
(321) 841-5078
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
10/11/2021
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