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PUBLIX SUPER MARKETS, INC.
RRC100292-00 SACRED HEART HOSPITAL ON THE EMERALD
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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 #1225
4739 HIGHWAY 90
PACE, FL 32571
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
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