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SMITH MANAGEMENT CORP DBA
DSH320021 PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
PRESBYTERIAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320021
Entity Address
1100 CENTRAL AVENUE SE
ALBUQUERQUE, NM 87106
Medicare Provider Number
320021
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
SMITH MANAGEMENT CORP DBA
Pharmacy Address
SMITH'S PHARMACY #414
2580 MAIN ST NE
LOS LUNAS, NM 87031
Pharmacy Comments
1/26/2010 - ADDRESS CHANGED FROM 47TH & 49TH NM ST. HWY. SAME LOCATION, BUT TOWN CHANGED STREET DESIGNATION.
Contract Details
Approval Date
4/10/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DALE MAXWELL, SENIOR VP & CFO
(505) 923-5353
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/10/2014
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