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PUBLIX ALABAMA, LLC
STD354012 West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services
Type
Sexually Transmitted Diseases
340B ID
STD354012
Entity Address
2703 7th Street
Tuscaloosa, AL 35401
Grant Number
6NH25PS005129-05-05
Participating Start Date
7/1/2018
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
PUBLIX ALABAMA, LLC
Pharmacy Address
PUBLIX PHARMACY #0075
4851 RICE MINE RD NE
SUITE 200
TUSCALOOSA, AL 35406
Pharmacy Comments
Contract Details
Approval Date
1/8/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Will Rainer, Chief Compliance Officer
(659) 734-2319
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
1/8/2024
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