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WALMART PHARMACY #10-5925
FQHCLA376A AIDS Action Coalition of Huntsville
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville
Subdivision Name
Thrive Alabama
Type
Health Center Program Look-Alike
340B ID
FQHCLA376A
Entity Address
600 St. Clair Avenue, Building 3
Huntsville, AL 35801-5008
Grant Number
LALCS32230
Participating Start Date
1/1/2019
Last Recertification Date
1/30/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-5925
Pharmacy Address
2305 JORDAN LN SW
HUNTSVILLE, AL 35805
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Elizabeth Marr, CEO
(256) 337-8283
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/11/2019
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