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PUBLIX SUPER MARKETS, INC.
RRC100157-00 LAKELAND REGIONAL MED CTR
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Covered Entity Details
Entity Name
LAKELAND REGIONAL MED CTR
Subdivision Name
Type
Rural Referral Center
340B ID
RRC100157-00
Entity Address
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Medicare Provider Number
100157
Participating Start Date
2/28/2018
Last Recertification Date
8/28/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX COMPOUNDING PHARMACY #3212
2424 ORLANDO CENTRAL PKWY STE 200
ORLANDO, FL 32809
Pharmacy Comments
Contract Details
Approval Date
4/18/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Evan Jones, EVP/Chief Financial Officer
(863) 687-1062
Contract Pharmacy Representative
Publix
Jacqueline Rusch, Manager of Managed Care
(863) 688-1188 Ext: 52364
Signed By Date
4/18/2017
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