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PUBLIX NORTH CAROLINA, LP
DSH340023 ADVENTHEALTH HENDERSONVILLE
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Covered Entity Details
Entity Name
ADVENTHEALTH HENDERSONVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340023
Entity Address
100 HOSPITAL DRIVE
HENDERSONVILLE, NC 28792
Medicare Provider Number
340023
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
PUBLIX NORTH CAROLINA, LP
Pharmacy Address
PUBLIX PHARMACY #1586
635 GREENVILLE HWY
HENDERSONVILLE, NC 28792
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Steven Burroughs, VP of Finance / CFO
(828) 681-2102
Contract Pharmacy Representative
Publix
Dain Rusk, Vice President
(863) 688-1188
Signed By Date
4/17/2023
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