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ALABAMA CVS PHARMACY, L.L.C.
STD36105 West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services - Beacon Center
Type
Sexually Transmitted Diseases
340B ID
STD36105
Entity Address
3091 Gaston Avenue
Unit B
Montgomery, AL 36105
Grant Number
6NH25PS005129-05-05
Participating Start Date
10/1/2023
Last Recertification Date
5/7/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
ALABAMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03095
6891 VAUGHN ROAD
MONTGOMERY, AL 36116
Pharmacy Comments
Contract Details
Approval Date
8/18/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Billy Kirkpatrick, Chief Executive Officer
(205) 759-8470 Ext: 7
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2023
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