Contract Pharmacy Details

Walgreens #21395
HV358011A AIDS Action Coalition of Huntsville

Covered Entity Details

Entity Name

AIDS Action Coalition of Huntsville

Subdivision Name

Thrive Alabama

Type

Ryan White Part C

340B ID

HV358011A

Entity Address

112 S. Pine Street
Florence, AL 35630

Grant Number

H76HA00624

Participating Start Date

1/1/2014

Last Recertification Date

2/11/2025

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

340B Drug Pricing Program Database