340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PUBLIX ALABAMA, LLC
RRC010024-00 JACKSON HOSPITAL AND CLINIC INC
Print
Covered Entity Details
Entity Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010024-00
Entity Address
1725 PINE STREET
MONTGOMERY, AL 36106-1109
Medicare Provider Number
010024
Participating Start Date
4/1/2017
Last Recertification Date
9/6/2022
Entity Termination Date
9/7/2022
Pharmacy Details
Pharmacy Name
PUBLIX ALABAMA, LLC
Pharmacy Address
PUBLIX PHARMACY #1756
9515 VAUGHN RD
PIKE ROAD, AL 36064-2292
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
11/8/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/7/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joe Riley, CEO
(334) 293-8809
Contract Pharmacy Representative
Publix Super Markets
Dain Rusk, Vice President Pharmacy
(863) 616-5846
Signed By Date
10/14/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session