Contract Pharmacy Details

PUBLIX PHARMACY #0426
CH04168D FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.

Covered Entity Details

Entity Name

FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.

Subdivision Name

FORT MYERS CENTER - DOWNTOWN

Type

HRSA-Funded Health Center

340B ID

CH04168D

Entity Address

2232 GRAND AVE
FORT MYERS, FL 33901-3717

Grant Number

H80CS00185

Participating Start Date

4/1/1995

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

PUBLIX PHARMACY #0426

Pharmacy Address

4600 SUMMERLIN ROAD
FT MYERS, FL 33919

Pharmacy Comments

Contract Details

Approval Date

4/16/2012

Contract Begin Date

4/16/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/17/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Roger Ward, Senior Vice President & Chief Operating Officer
(239) 332-0417

Contract Pharmacy Representative

Fred Ottlino, Vice President Pharmacy
(863) 688-1188 Ext: 52352

Signed By Date

4/9/2012

340B Drug Pricing Program Database