Contract Pharmacy Details

CVS PHARMACY, INC.
RWII35233 Birmingham AIDS Outreach, Inc.

Covered Entity Details

Entity Name

Birmingham AIDS Outreach, Inc.

Subdivision Name

Magic City Wellness Center

Type

Ryan White Part B

340B ID

RWII35233

Entity Address

3220 5th Avenue South
Suite 100
Birmingham, AL 35222

Grant Number

X07HA00049

Participating Start Date

10/1/2016

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

CVS PHARMACY # 17510
1415 EGLIN ST
RAPID CITY, SD 57701

Pharmacy Comments

Contract Details

Approval Date

1/11/2022

Contract Begin Date

1/20/2022

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

1/11/2022

340B Drug Pricing Program Database