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PUBLIX SUPER MARKETS, INC.
DSH100157 LAKELAND REGIONAL MED CTR
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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 #3213
1950 SAND LAKE ROAD #5
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
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
Katie Scanlon, Manager of Managed Care
(863) 688-1188 Ext: 52364
Signed By Date
10/14/2014
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