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PUBLIX ALABAMA, LLC
RWII36105 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
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 #1027
3026 ZELDA ROAD
MONTGOMERY, AL 36106-2651
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
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