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WAL-MART PHARMACY 10-0287
STD35233 BIRMINGHAM AIDS OUTREACH INC.
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Covered Entity Details
Entity Name
BIRMINGHAM AIDS OUTREACH INC.
Subdivision Name
Magic City Wellness Center
Type
Sexually Transmitted Diseases
340B ID
STD35233
Entity Address
3220 5th Avenue South
Suite 100
Birmingham, AL 35222
Grant Number
5 NH25PS005129-04
Participating Start Date
1/1/2017
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0287
Pharmacy Address
1801 HIGHWAY 78 EAST
JASPER, AL 35501
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
5/26/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KAREN MUSGROVE, EXECUTIVE DIRECTOR
(205) 322-4197
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2021
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