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PUBLIX SUPER MARKETS, INC.
STD33777 Empath Health, Inc
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Covered Entity Details
Entity Name
Empath Health, Inc
Subdivision Name
AIDS Service Association of Pinellas dba EPIC
Type
Sexually Transmitted Diseases
340B ID
STD33777
Entity Address
8787 Bryan Dairy Rd
230
Largo, FL 33777
Grant Number
1NU62PS924687-1-00
Participating Start Date
8/16/2023
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #3219
300 PINELLAS ST.
CLEARWATER, FL 33756
Pharmacy Comments
Contract Details
Approval Date
7/22/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
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
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