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WINN DIXIE STORE #171
CH042710 TRENTON MEDICAL CENTER
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Covered Entity Details
Entity Name
TRENTON MEDICAL CENTER
Subdivision Name
Palms Medical Group - Trenton
Type
HRSA-Funded Health Center
340B ID
CH042710
Entity Address
911 South Main street
Trenton, FL 32693
Grant Number
H80CS00691
Participating Start Date
10/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE STORE #171
Pharmacy Address
727 W NOBLE AVENUE
WILLISTON, FL 32696
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2023
Ownership change
Contacts
Covered Entity Signing Official
Anita Rembert, CEO
(352) 463-4501
Contract Pharmacy Representative
Curtis Hartin, Director of Pharmacy
(904) 370-7776
Signed By Date
4/14/2014
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