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WALGREEN CO.
STD36111 West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services
Type
Sexually Transmitted Diseases
340B ID
STD36111
Entity Address
2900 McGehee Road
Montgomery, AL 36111
Grant Number
6NH25PS005129-05-05
Participating Start Date
10/1/2017
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07404
2041 E MAIN STREET
DOTHAN, AL 36301
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
1/1/2020
Business decision by covered entity and/or pharmacy
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
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