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WINN-DIXIE PHARMACY #572
RWIID361301 ALABAMA DEPARTMENT OF PUBLIC HEALTH
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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 #572
Pharmacy Address
5440 US HWY 90 WEST
MOBILE, AL 36619
Pharmacy Comments
Contract Details
Approval Date
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
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
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