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PUBLIX SUPER MARKETS INC. PUIBLIX PHARMACY #1038
DSH100113 SHANDS TEACHING HOSPITAL AND CLINICS, INC.
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Covered Entity Details
Entity Name
SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100113
Entity Address
1600 SW Archer Road
GAINESVILLE, FL 32610
Medicare Provider Number
100113
Participating Start Date
7/1/1993
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS INC. PUIBLIX PHARMACY #1038
Pharmacy Address
5200 SW 34th Street
Gainesville, FL 32608
Pharmacy Comments
Contract Details
Approval Date
3/19/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Edward Jimenez, CEO
(352) 265-0440
Contract Pharmacy Representative
Publix Super Markets
Fred Ottolino, Vice President of Pharmacy Operations
(863) 688-1188
Signed By Date
1/15/2013
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