Contract Pharmacy Details

WALGREEN CO.
HV0413130B Montgomery AIDS Outreach, Inc

Covered Entity Details

Entity Name

Montgomery AIDS Outreach, Inc

Subdivision Name

Wellness Center

Type

Ryan White Part C

340B ID

HV0413130B

Entity Address

3050 McGehee Road
Montomery, AL 36111

Grant Number

H76HA00099

Participating Start Date

7/1/2019

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15258
1758 PARK PL
SUITE 102
MONTGOMERY, AL 36106

Pharmacy Comments

Contract Details

Approval Date

7/17/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/19/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Michael R. Murphree, Chief Executive Officer
(334) 280-3349 Ext: 1001

Contract Pharmacy Representative

MAO
Ashley M. Tarrant, Interim CEO
(334) 386-0854

Signed By Date

7/17/2019

340B Drug Pricing Program Database