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WALGREEN CO
HV358011 AIDS ACTION COALITION/DAVIS CLINIC
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Covered Entity Details
Entity Name
AIDS ACTION COALITION/DAVIS CLINIC
Subdivision Name
Type
Ryan White Part C
340B ID
HV358011
Entity Address
600 ST CLAIR BLDG 3
HUNTSVILLE, AL 35801
Grant Number
H76HA00624
Participating Start Date
4/1/2001
Last Recertification Date
1/30/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11180
1700 2ND AVENUE SOUTHWEST
CULLMAN, AL 35055-5397
Pharmacy Comments
Contract Details
Approval Date
10/25/2012
Contract Begin Date
10/25/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Elizabeth Marr, Chief Executive Officer
(256) 536-4700 Ext: 121
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/25/2012
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