Contract Pharmacy Details

TENNESSEE CVS PHARMACY, L.L.C.
STD35233 BIRMINGHAM AIDS OUTREACH INC.

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

TENNESSEE CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 17099
780 OLD HICKORY BLVD
BRENTWOOD, TN 37027

Pharmacy Comments

Contract Details

Approval Date

4/14/2022

Contract Begin Date

4/18/2022

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

4/14/2022

340B Drug Pricing Program Database