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Walgreens #21395
STD35630 AIDS Action Coalition of Huntsville
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville
Subdivision Name
Thrive Alabama
Type
Sexually Transmitted Diseases
340B ID
STD35630
Entity Address
112 South Pine St
Florence, AL 35630
Grant Number
5 NH25PS005129-05-00
Participating Start Date
4/1/2017
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
Walgreens #21395
Pharmacy Address
Walgreens Central Fill #21395
5710 Young Pine Rd
Orlando, FL 32829
Pharmacy Comments
Contract Details
Approval Date
10/3/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/9/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Elizabeth Marr, CEO
(256) 337-8283
Contract Pharmacy Representative
Walgreens
Joyce Abraham, Analyst, 340B Client Relationship
(847) 964-6382
Signed By Date
10/3/2022
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