340B Drug Pricing Program Database
WALMART PHARMACY 10-5169
CAH321301-00 SOCORRO GENERAL HOSPITAL - information as of 4/28/2025 1:02:37 AM
Covered Entity Details
Entity Name
SOCORRO GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321301-00
Entity Address
1202 HIGHWAY 60 WEST
SOCORRO, NM 87801
Medicare Provider Number
321301
Participating Start Date
1/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/6/2023
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