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WAL-MART PHARMACY 10-1357
SCH320016-00 GILA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
GILA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH320016-00
Entity Address
1313 E 32ND STREET
SILVER CITY, NM 88061
Medicare Provider Number
320016
Participating Start Date
4/1/2018
Last Recertification Date
8/19/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1357
Pharmacy Address
2501 HWY. 180 EAST
SILVER CITY, NM 88061
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gregory W Brickner, Interim CFO
(575) 538-4130
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/9/2021
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