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PUBLIX SUPER MARKETS
CH04168D FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
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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 SUPER MARKETS
Pharmacy Address
PUBLIX PHARMACY #0755
4265 TAMIAMI TRAIL
PORT CHARLOTTE, FL 33980
Pharmacy Comments
Contract Details
Approval Date
10/31/2012
Contract Begin Date
10/31/2012
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
Robert L. Johns, Senior VP
(239) 332-0417
Contract Pharmacy Representative
Publix Super Markets
Fred Ottolino, Vice President of Pharmacy Operations
(863) 688-1188
Signed By Date
9/5/2012
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