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WAL-MART PHARMACY 10-5113
HV358011 AIDS ACTION COALITION/DAVIS CLINIC
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Covered Entity Details
Entity Name
AIDS ACTION COALITION/DAVIS CLINIC
Subdivision Name
Type
Ryan White Part C
340B ID
HV358011
Entity Address
600 ST CLAIR BLDG 3
HUNTSVILLE, AL 35801
Grant Number
H76HA00624
Participating Start Date
4/1/2001
Last Recertification Date
1/30/2019
Entity Termination Date
4/1/2020
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
4/1/2020
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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