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PUBLIX SUPER MARKETS, INC.
CAN100079-00 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN100079-00
Entity Address
1475 NW 12th Avenue
2080A
Miami, FL 33136
Medicare Provider Number
100079
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX CENTRAL PHARMACY #3201
2424 ORLANDO CENTRAL PARKWAY
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
10/2/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICHARD BALLARD, HOSPITAL ADMINISTRATOR/CEO
(305) 243-4382
Contract Pharmacy Representative
Johanna Bautista, 340B Program Manager for University of Miami
(305) 243-2223
Signed By Date
10/2/2015
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