Contract Pharmacy Details

WINN DIXIE PHARMACY #521
RWIID361301 ALABAMA DEPARTMENT OF PUBLIC HEALTH

Covered Entity Details

Entity Name

ALABAMA DEPARTMENT OF PUBLIC HEALTH

Subdivision Name

HIV AIDS DIVISION

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID361301

Entity Address

201 Monroe Street
Suite 1200
MONTGOMERY, AL 36104

Grant Number

X07HA00049

Participating Start Date

1/1/2004

Last Recertification Date

3/2/2025

Pharmacy Details

Pharmacy Name

WINN DIXIE PHARMACY #521

Pharmacy Address

3881 ATLANTA HWY
MONTGOMERY, AL 36109

Pharmacy Comments

Contract Details

Approval Date

1/10/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/21/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Allison Hatchett, Alabama RWHAP Part B Director
(334) 206-2615

Contract Pharmacy Representative

Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455

Signed By Date

1/10/2018

340B Drug Pricing Program Database