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WALMART PHARMACY 10-5169
DSH320004 CHRISTUS Southern New Mexico
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Covered Entity Details
Entity Name
CHRISTUS Southern New Mexico
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320004
Entity Address
2669 SCENIC DR
ALAMOGORDO, NM 88310-8734
Medicare Provider Number
320004
Participating Start Date
4/1/2015
Last Recertification Date
9/10/2024
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
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/15/2024
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