Contract Pharmacy Details

PUBLIX SUPER MARKETS, INC.
STD33712 Empath Health, Inc.

Covered Entity Details

Entity Name

Empath Health, Inc.

Subdivision Name

AIDS Service Association of Pinellas dba EPIC

Type

Sexually Transmitted Diseases

340B ID

STD33712

Entity Address

3050 1st Ave S
St. Petersburg, FL 33712

Grant Number

1NU62PS924687-1-00

Participating Start Date

4/1/2018

Last Recertification Date

5/9/2024

Pharmacy Details

Pharmacy Name

PUBLIX SUPER MARKETS, INC.

Pharmacy Address

PUBLIX PHARMACY #1371
3863 SOUTH US HIGHWAY 301
RIVERVIEW, FL 33578

Pharmacy Comments

Contract Details

Approval Date

7/22/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Saida Bouhamid, Chief Mission Financial Officer
(727) 523-3339

Contract Pharmacy Representative

Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388

Signed By Date

7/22/2024

340B Drug Pricing Program Database