340B Drug Pricing Program Database
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PUBLIX SUPER MARKETS, INC.
DSH420086 PRISMA HEALTH BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420086
Entity Address
1333 Taylor Street
COLUMBIA, SC 29202
Medicare Provider Number
420086
Participating Start Date
7/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #0067
2800 ROSEWOOD DRIVE
COLUMBIA, SC 29205
Pharmacy Comments
Contract Details
Approval Date
4/20/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Bundy, Chief Executive Officer
(803) 296-5782
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
4/20/2022
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