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PRESBYTERIAN SPECIALTY CARE PHARMACY
DSH320011 ESPANOLA HOSPITAL
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Covered Entity Details
Entity Name
ESPANOLA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320011
Entity Address
1010 SPRUCE STREET
ESPANOLA, NM 87532
Medicare Provider Number
320011
Participating Start Date
4/1/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
PRESBYTERIAN SPECIALTY CARE PHARMACY
Pharmacy Address
4580 PARADISE BLVD. NW
ALBUQUERQUE, NM 87114-4105
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
4/7/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Scott Graham, VP-PDS Clinical Support Srvc
(505) 841-1872
Contract Pharmacy Representative
Presbyterian Specialty Care Pharmacy
MATTHEW NAGY, ENTERPRISE WIDE DIRECTOR OF PHARMACY
(505) 841-1872
Signed By Date
4/7/2021
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