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WAL-MART PHARMACY 10-1357
CH06723M HIDALGO MEDICAL SERVICES
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES
Subdivision Name
HMS ANIMAS VALLEY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06723M
Entity Address
1356 State HWY 9
ANIMAS, NM 88020
Grant Number
H80CS00744
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1357
Pharmacy Address
2501 HWY. 180 EAST
SILVER CITY, NM 88061
Pharmacy Comments
Contract Details
Approval Date
10/16/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Otero, CEO
(575) 590-7090
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2020
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