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PUBLIX SUPER MARKETS, INC.
DSH440039 Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
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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 SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #3213
1950 SAND LAKE ROAD #5
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
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
Cecelia B Moore, Associate Vice Chancellor
(615) 322-0084
Contract Pharmacy Representative
Katie Scanlon, Manager of Managed Care
(863) 688-1188 Ext: 52364
Signed By Date
10/15/2014
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