340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PUBLIX SUPER MARKETS
RRC100307-00 ST. VINCENTS MEDICAL CENTER SOUTHSID
Print
Covered Entity Details
Entity Name
ST. VINCENTS MEDICAL CENTER SOUTHSID
Subdivision Name
Type
Rural Referral Center
340B ID
RRC100307-00
Entity Address
4201 BELFORT ROAD
JACKSONVILLE, FL 32216
Medicare Provider Number
100307
Participating Start Date
10/1/2020
Last Recertification Date
8/20/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS
Pharmacy Address
PUBLIX PHARMACY #0393
11250-4 OLD ST. AUGUSTINE ROAD
JACKSONVILLE, FL 32257
Pharmacy Comments
Contract Details
Approval Date
1/21/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Contract Pharmacy Representative
Publix Super Markets
Dain Rusk, Vice President Pharmacy
(863) 616-5846
Signed By Date
1/21/2022
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