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Walmart Pharmacy 10-7611
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
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew C Stephens, Associate Administrator
(575) 538-4041
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/1/2024
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