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WALMART PHARMACY 10-5169
DSH320022 PLAINS REGIONAL MEDICAL CENTER - CLOVIS
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Covered Entity Details
Entity Name
PLAINS REGIONAL MEDICAL CENTER - CLOVIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320022
Entity Address
2100 NORTH DR MARTIN LUTHER KING JR BLVD
CLOVIS, NM 88101
Medicare Provider Number
320022
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/6/2023
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