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PUBLIX SUPER MARKETS, INC.
DSH100132 SOUTH FLORIDA BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
SOUTH FLORIDA BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100132
Entity Address
3202 N Park Rd
PLANT CITY, FL 33563
Medicare Provider Number
100132
Participating Start Date
1/1/2004
Last Recertification Date
8/26/2024
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
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
BayCare Health System
Michael Magee, Vice President of Pharmacy
(813) 870-4020
Signed By Date
1/5/2018
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