340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PUBLIX ALABAMA, LLC
DSH010024 JACKSON HOSPITAL AND CLINIC INC
Print
Covered Entity Details
Entity Name
JACKSON HOSPITAL AND CLINIC INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010024
Entity Address
1725 PINE STREET
MONTGOMERY, AL 36106-1109
Medicare Provider Number
010024
Participating Start Date
9/7/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
PUBLIX ALABAMA, LLC
Pharmacy Address
PUBLIX PHARMACY #1756
9515 VAUGHN RD
PIKE ROAD, AL 36064-2292
Pharmacy Comments
Contract Details
Approval Date
9/9/2022
Contract Begin Date
9/12/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/26/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joe Riley, CEO
(334) 293-8809
Contract Pharmacy Representative
Publix
Kimberly Bone, Manager of Managed Care, Pharmacy Operations
(863) 688-1188 Ext: 52364
Signed By Date
9/9/2022
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