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WALGREEN CO.
CH06723U Hidalgo Medical Services
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Covered Entity Details
Entity Name
Hidalgo Medical Services
Subdivision Name
HMS Mining District Clinic
Type
HRSA-Funded Health Center
340B ID
CH06723U
Entity Address
517 East St
Santa Clara, NM 88026
Grant Number
H80CS00744
Participating Start Date
4/7/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10808
100 ROSEDALE RD.
SILVER CITY, NM 88061-8742
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Otero, CEO
(575) 590-7090
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/6/2021
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