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WALMART PHARMACY 10-5459
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
WALMART PHARMACY 10-5459
Pharmacy Address
105 MARKET STREET
STARKVILLE, MS 39759
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
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
4/15/2024
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