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WAL-MART PHARMACY 10-0906
DSH320001 UNIVERSITY OF NEW MEXICO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF NEW MEXICO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320001
Entity Address
2211 Lomas Blvd NE
ALBUQUERQUE, NM 87106
Medicare Provider Number
320001
Participating Start Date
9/1/1993
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0906
Pharmacy Address
1650WEST MALONEY AVENUE
GALLUP, NM 87301
Pharmacy Comments
Contract Details
Approval Date
10/16/2020
Contract Begin Date
11/2/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bonnie White, Chief Financial Officer
(505) 272-1840
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2020
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