Contract Pharmacy Details

WALGREEN CO.
HV0413130 MONTGOMERY AIDS OUTREACH, INC.

Covered Entity Details

Entity Name

MONTGOMERY AIDS OUTREACH, INC.

Subdivision Name

Type

Ryan White Part C

340B ID

HV0413130

Entity Address

2900 McGehee Road
MONTGOMERY, AL 36111

Grant Number

H76HA00099

Participating Start Date

10/1/1995

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02203
3892 ATLANTA HWY
MONTGOMERY, AL 36109-3626

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

10/1/2019
Agreement registered in error

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