Contract Pharmacy Details

WAL-MART PHARMACY 10-0930
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

WAL-MART PHARMACY 10-0930

Pharmacy Address

3801 EASTERN BLVD.
MONTGOMERY, AL 36116

Pharmacy Comments

Contract Details

Approval Date

1/12/2024

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

1/12/2024

340B Drug Pricing Program Database