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CVS PHARMACY, INC.
CH06723B HIDALGO MEDICAL SERVICES
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES
Subdivision Name
HMS Mimbres Community Clinic
Type
HRSA-Funded Health Center
340B ID
CH06723B
Entity Address
2672 Hwy 35
San Lorenzo, NM 88041
Grant Number
H80CS00744
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 10449
610 SILVER HEIGHTS BLVD.
SILVER CITY, NM 88061
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2021
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