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WALMART PHARMACY 10-5169
DSH320089 UNM SANDOVAL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UNM SANDOVAL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320089
Entity Address
3001 BROADMOOR BLVD NE
RIO RANCHO, NM 87144
Medicare Provider Number
320089
Participating Start Date
4/1/2016
Last Recertification Date
8/17/2023
Entity Termination Date
4/1/2024
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
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jamie Silva-Steele, President and CEO
(505) 994-7430
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/11/2023
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