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WAL-MART PHARMACY 10-5315
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 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Matthew C Stephens, Associate Administrator
(575) 538-4041
Contract Pharmacy Representative
Gila Regional Medical Center
Matthew C Stephens, Associate Administrator
(575) 538-4041
Signed By Date
4/15/2024
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