Contract Pharmacy Details

PUBLIX SUPER MARKETS INC
RRC100292-00 SACRED HEART HOSPITAL ON THE EMERALD

Covered Entity Details

Entity Name

SACRED HEART HOSPITAL ON THE EMERALD

Subdivision Name

Type

Rural Referral Center

340B ID

RRC100292-00

Entity Address

7800 US HIGHWAY 98 WEST
DESTIN, FL 32550

Medicare Provider Number

100292

Participating Start Date

1/1/2021

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

PUBLIX SUPER MARKETS INC

Pharmacy Address

PUBLIX PHARMACY #0801
2250 SOUTH FERDON BOULEVARD
CRESTVIEW, FL 32536

Pharmacy Comments

Contract Details

Approval Date

1/24/2022

Contract Begin Date

1/24/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/15/2023
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

1/24/2022

340B Drug Pricing Program Database