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WAL-MART PHARMACY 10-1357
CAH321311-00 GILA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
GILA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321311-00
Entity Address
1313 EAST 32ND STREET
SILVER CITY, NM 88061
Medicare Provider Number
321311
Participating Start Date
7/1/2022
Last Recertification Date
8/13/2024
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
6/29/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul H Rogers, CFO
(941) 320-2498
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
6/29/2022
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