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WAL-MART PHARMACY #10-2488
CHC33642-03 AIDS Action Coalition of Huntsville
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville
Subdivision Name
Thrive Pediatrics
Type
HRSA-Funded Health Center
340B ID
CHC33642-03
Entity Address
3007 Memorial Parkway South
Suite C Unit 2
Huntsville, AL 35801-7420
Grant Number
H80CS33642
Participating Start Date
7/1/2022
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY #10-2488
Pharmacy Address
1203 6TH AVE SE
DECATUR, AL 35601
Pharmacy Comments
Contract Details
Approval Date
4/20/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Elizabeth Marr, CEO
(256) 337-8283
Contract Pharmacy Representative
Wellpartner
Jordana Nardiello, Account Manager
(516) 580-1278
Signed By Date
4/20/2022
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