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WALMART PHARMACY 10-5169
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
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/9/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Will Rainer, Chief Compliance Officer
(659) 734-2319
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/9/2024
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