340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PUBLIX SUPER MARKETS, INC.
DSH100157 LAKELAND REGIONAL MED CTR
Print
Covered Entity Details
Entity Name
LAKELAND REGIONAL MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100157
Entity Address
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Medicare Provider Number
100157
Participating Start Date
1/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #1707
5375 N SOCRUM LOOP RD
LAKELAND, FL 33809-4256
Pharmacy Comments
Contract Details
Approval Date
7/8/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Evan C. Jones, Executive VP & CFO
(863) 687-1062
Contract Pharmacy Representative
Publix Super Markets
Fred Ottolino, Vice President of Pharmacy Operations
(863) 688-1188
Signed By Date
7/8/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session