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WAL-MART CENTRAL FILL 10-2670
CHC26510-00 Southwest Colorado Mental Health Center, Inc.
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Covered Entity Details
Entity Name
Southwest Colorado Mental Health Center, Inc.
Subdivision Name
Cortez Integrated Healthcare
Type
HRSA-Funded Health Center
340B ID
CHC26510-00
Entity Address
691 E EMPIRE ST
CORTEZ, CO 81321-2802
Grant Number
H80CS26510
Participating Start Date
4/1/2020
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/6/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela Wise Romero, COO
(970) 335-2202
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/13/2020
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