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PUBLIX SUPER MARKETS, INC
DSH100007 AdventHealth Orlando
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Covered Entity Details
Entity Name
AdventHealth Orlando
Subdivision Name
Florida Hospital Orlando
Type
Disproportionate Share Hospital
340B ID
DSH100007
Entity Address
601 E. Rollins St.
Orlando, FL 32803-1248
Medicare Provider Number
100007
Participating Start Date
4/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC
Pharmacy Address
PUBLIX PHARMACY #1092
3400 AVALON PARK EAST BLVD
ORLANDO, FL 32828
Pharmacy Comments
Contract Details
Approval Date
1/4/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Myers, Senior Vice President Finance
(407) 303-5501
Contract Pharmacy Representative
Publix
Dain Rusk, Vice President
(863) 688-1188
Signed By Date
1/4/2023
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