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WAL-MART PHARMACY 10-5113
HV358011A AIDS Action Coalition of Huntsville
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville
Subdivision Name
Thrive Alabama
Type
Ryan White Part C
340B ID
HV358011A
Entity Address
112 S. Pine Street
Florence, AL 35630
Grant Number
H76HA00624
Participating Start Date
1/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5113
Pharmacy Address
165 VAUGHAN LN
PELL CITY, AL 35125
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Elizabeth Marr, Chief Executive Officer
(256) 536-4700 Ext: 121
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/16/2017
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