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CVS PHARMACY, INC.
DSH320011 ESPANOLA HOSPITAL
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Covered Entity Details
Entity Name
ESPANOLA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320011
Entity Address
1010 SPRUCE STREET
ESPANOLA, NM 87532
Medicare Provider Number
320011
Participating Start Date
4/1/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 10227
2907 CERRILLOS RD.
SANTA FE, NM 87507
Pharmacy Comments
Contract Details
Approval Date
1/17/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sandra C. Podley, VP Operations PDS
(505) 923-5364
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2019
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