Contract Pharmacy Details

WALMART PHARMACY #10-5925
FQHCLA376B AIDS Action Coalition of Huntsville

Covered Entity Details

Entity Name

AIDS Action Coalition of Huntsville

Subdivision Name

Thrive Alabama

Type

Health Center Program Look-Alike

340B ID

FQHCLA376B

Entity Address

600 St. Clair Ave, Building 9 STE 23
Huntsville, AL 35801-5057

Grant Number

LALCS32230

Participating Start Date

4/1/2019

Last Recertification Date

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

340B Drug Pricing Program Database