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WAL-MART PHARMACY 10-5315
DSH450024 UNIVERSITY MEDICAL CENTER OF EL PASO
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF EL PASO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450024
Entity Address
4815 ALAMEDA AVE.
EL PASO, TX 79905
Medicare Provider Number
450024
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/23/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHAEL NUNEZ, CFO
(915) 521-7626
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/23/2018
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