340B Drug Pricing Program Database
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PUBLIX SUPER MARKETS, INC.
DSH100157 LAKELAND REGIONAL MED CTR
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Covered Entity Details
Entity Name
LAKELAND REGIONAL MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100157
Entity Address
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Medicare Provider Number
100157
Participating Start Date
1/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #1366
5140 COUNTY LINE ROAD
LAKELAND, FL 33811
Pharmacy Comments
Contract Details
Approval Date
1/15/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lance Green, EVP/Chief Financial Officer
(863) 687-1100 Ext: 5225
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
1/15/2022
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