Contract Pharmacy Details

PUBLIX SUPER MARKETS, INC.
RW424835C St. Josephs Hospital

Covered Entity Details

Entity Name

St. Josephs Hospital

Subdivision Name

Tampa Care Clinic

Type

Ryan White Part D

340B ID

RW424835C

Entity Address

4600 North Habana Avenue
Suite 15
Tampa, FL 33614

Grant Number

H12HA24835

Participating Start Date

7/1/2016

Last Recertification Date

2/26/2025

Pharmacy Details

Pharmacy Name

PUBLIX SUPER MARKETS, INC.

Pharmacy Address

PUBLIX PHARMACY #3221
3003 W. DR. MARTIN LUTHER KING JR. BLVD.
TAMPA, FL 33607

Pharmacy Comments

Contract Details

Approval Date

1/5/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/13/2018
Agreement registered in error

Contacts

Covered Entity Signing Official

Carl Tremonti, Chief Financial Officer
(813) 870-4020

Contract Pharmacy Representative

BayCare Health System
Michael Magee, Vice President of Pharmacy
(813) 870-4020

Signed By Date

1/5/2018

340B Drug Pricing Program Database