Contract Pharmacy Details

WALGREEN CO.
HV0413130A MONTGOMERY AIDS OUTREACH, INC.

Covered Entity Details

Entity Name

MONTGOMERY AIDS OUTREACH, INC.

Subdivision Name

Dothan

Type

Ryan White Part C

340B ID

HV0413130A

Entity Address

1865 Honeysuckle Road
Suite 3
Dothan, AL 36305

Grant Number

H76HA00099

Participating Start Date

4/1/2013

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06843
2281 E SOUTH BLVD
MONTGOMERY, AL 36116-2488

Pharmacy Comments

Contract Details

Approval Date

7/10/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ashley M. Tarrant, Interim CEO
(334) 386-0854

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/10/2013

340B Drug Pricing Program Database