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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 #19058
4030 W MAIN ST STE 100 & 101
DOTHAN, AL 36305
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2024
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