Contract Pharmacy Details

PUBLIX ALABAMA, LLC
RWII36105 West Alabama AIDS Outreach

Covered Entity Details

Entity Name

West Alabama AIDS Outreach

Subdivision Name

Five Horizons Health Services - Beacon Center

Type

Ryan White Part B

340B ID

RWII36105

Entity Address

3091 Gaston Avenue
Unit B
Montgomery, AL 36105

Grant Number

X07HA00049

Participating Start Date

10/1/2023

Last Recertification Date

1/29/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

PUBLIX ALABAMA, LLC

Pharmacy Address

PUBLIX PHARMACY #1025
4045 ATLANTA HIGHWAY
MONTGOMERY, AL 36109-2920

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

Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388

Signed By Date

1/9/2024

340B Drug Pricing Program Database