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WAL-MART PHARMACY 10-0332
FQHCLA376B 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
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
WAL-MART PHARMACY 10-0332
Pharmacy Address
6140-A UNIVERSITY DR
HUNTSVILLE, AL 35806
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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