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WALGREEN CO
CH06723A HIDALGO MEDICAL SERVICES, INC
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES, INC
Subdivision Name
HMS MED SQUARE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06723A
Entity Address
114 W 11th St
Silver City, NM 88061-5136
Grant Number
H80CS00744
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS
2370 E MAIN STREET
WOODLAND, CA 95776
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
Genoa, a QoL Healthcare Company
Larry Hart, RPH
(412) 613-4434
Signed By Date
10/16/2020
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