Contract Pharmacy Details

PUBLIX TENNESSEE, LLC
DSH440039 Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic

Covered Entity Details

Entity Name

Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH440039

Entity Address

1211 MEDICAL CENTER DRIVE
NASHVILLE, TN 37232

Medicare Provider Number

440039

Participating Start Date

7/1/2002

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

PUBLIX TENNESSEE, LLC

Pharmacy Address

PUBLIX PHARMACY #1298
6614 CHARLOTTE PIKE
NASHVILLE, TN 37209

Pharmacy Comments

Contract Details

Approval Date

4/19/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/8/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Phyllis Ekdall, Vice President of Finance, Clinical Enterprise
(615) 322-8801

Contract Pharmacy Representative

Publix Super Markets
Fred Ottolino, Vice President of Pharmacy Operations
(863) 688-1188

Signed By Date

4/19/2013

340B Drug Pricing Program Database