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WALGREEN CO.
STD354012 West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services
Type
Sexually Transmitted Diseases
340B ID
STD354012
Entity Address
2703 7th Street
Tuscaloosa, AL 35401
Grant Number
6NH25PS005129-05-05
Participating Start Date
7/1/2018
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
JIM MYERS A WALGREENS PHARMACY #15449
1520 MCFARLAND BLVD N
SUITE B
TUSCALOOSA, AL 35406
Pharmacy Comments
Contract Details
Approval Date
5/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Billy Kirkpatrick, Chief Executive Officer
(205) 759-8470 Ext: 7
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2018
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