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WALGREEN CO.
RWII354011B West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services - Selma
Type
Ryan White Part B
340B ID
RWII354011B
Entity Address
1023 Medical Center Parkway
STE 308
Selma, AL 36701
Grant Number
X07HA00049
Participating Start Date
1/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18125
4200 MCFARLAND BLVD E STE 6
TUSCALOOSA, AL 35405
Pharmacy Comments
Contract Details
Approval Date
11/3/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/6/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Will Rainer, Chief Compliance Officer
(659) 734-2319
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2023
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