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WALMART PHARMACY #10-4210
HV047080 MOBILE COUNTY BOARD OF HEALTH
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Covered Entity Details
Entity Name
MOBILE COUNTY BOARD OF HEALTH
Subdivision Name
RYAN WHITE CLINIC
Type
Ryan White Part C
340B ID
HV047080
Entity Address
251 NORTH BAYOU STREET
MOBILE, AL 36603
Grant Number
H76HA00081
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-4210
Pharmacy Address
1300 NORTH UNIVERSITY
MOBILE, AL 36618
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/28/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kelly R Warren, Executive Director
(251) 690-8832
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2020
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