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PUBLIX SUPER MARKETS, INC
DSH100063 MORTON PLANT NORTH BAY HOSPITAL
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Covered Entity Details
Entity Name
MORTON PLANT NORTH BAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100063
Entity Address
6600 MADISON STREET
NEW PORT RICHEY, FL 34652-1971
Medicare Provider Number
100063
Participating Start Date
1/1/2015
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC
Pharmacy Address
PUBLIX PHARMACY #0810
11400 RIDGE RD
NEW PORT RICHEY, FL 34654
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Publix
Jacqueline Rusch, Manager of Managed Care
(863) 688-1188 Ext: 52364
Signed By Date
7/14/2017
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