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PUBLIX PHARMACY
STD3280612 Sunshine Specialty Health Outreach Foundation
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Covered Entity Details
Entity Name
Sunshine Specialty Health Outreach Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD3280612
Entity Address
220 E. Gore St
Orlando, FL 32806
Grant Number
5nu62ps924532-02
Participating Start Date
10/12/2022
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
PUBLIX PHARMACY
Pharmacy Address
PUBLIX PHARMACY #0436
2873 S. ORANGE AVE
ORLANDO, FL 32806
Pharmacy Comments
Contract Details
Approval Date
4/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jillian Hall, President
(407) 325-1299
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
4/16/2023
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