340B Drug Pricing Program Database
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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 #1388
741 S. ORLANDO AVE
WINTER PARK, FL 32789
Pharmacy Comments
Contract Details
Approval Date
1/10/2022
Contract Begin Date
4/1/2022
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
1/10/2022
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