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SENDERRA RX PHARMACY
CAH321300-00 SIERRA VISTA HOSPITAL
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Covered Entity Details
Entity Name
SIERRA VISTA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321300-00
Entity Address
800 EAST 9TH AVE.
TRUTH OR CONSEQUENCES, NM 87901-1961
Medicare Provider Number
321300
Participating Start Date
7/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SENDERRA RX PHARMACY
Pharmacy Address
SENDERRA RX PARTNERS, LLC
3712 E PLANO PKWY STE 200
PLANO, TX 75074
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Lee Stokes, CEO
(575) 894-2111
Contract Pharmacy Representative
Senderra Rx Specialty Pharmacy
Galina Davis, Manager Managed Care Strategies
(214) 446-9404
Signed By Date
7/15/2021
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