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BOSWELL PHARMACY SERVICES, LLC
STD87504 New Mexico Corrections Department
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Covered Entity Details
Entity Name
New Mexico Corrections Department
Subdivision Name
Penitentiary of New Mexico
Type
Sexually Transmitted Diseases
340B ID
STD87504
Entity Address
4311 State Highway 14
Santa Fe, NM 87504
Grant Number
NH25PS005180
Participating Start Date
7/1/2020
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
BOSWELL PHARMACY SERVICES, LLC
Pharmacy Address
131 SCHOOLHOUSE ROAD
P O BOX 266
JENNERSTOWN, PA 15547
Pharmacy Comments
Contract Details
Approval Date
7/1/2020
Contract Begin Date
7/9/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wence J Asonganyi, Health Services Administrator
(505) 629-7753
Contract Pharmacy Representative
BosWell Pharmacy Services
Jacqueline M Martella, pharmacist
(888) 688-3288
Signed By Date
7/1/2020
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