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WAL-MART PHARMACY 10-0873
CH060330 EL CENTRO FAMILY HEALTH
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Covered Entity Details
Entity Name
EL CENTRO FAMILY HEALTH
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH060330
Entity Address
620 CORONADO STREET
ESPANOLA, NM 87532
Grant Number
H80CS00605
Participating Start Date
8/1/1993
Last Recertification Date
3/8/2016
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0873
Pharmacy Address
926 PASEO DEL PUEBLO SUR
TAOS, NM 87571
Pharmacy Comments
Contract Details
Approval Date
7/23/2012
Contract Begin Date
7/23/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Contacts
Covered Entity Signing Official
Lore Pease, CEO
(505) 753-7218
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/11/2012
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