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PRESBYTERIAN HEALTHCARE SERVICES DBA
DSH320022 PLAINS REGIONAL MEDICAL CENTER - CLOVIS
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Covered Entity Details
Entity Name
PLAINS REGIONAL MEDICAL CENTER - CLOVIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320022
Entity Address
2100 NORTH DR MARTIN LUTHER KING JR BLVD
CLOVIS, NM 88101
Medicare Provider Number
320022
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
PRESBYTERIAN HEALTHCARE SERVICES DBA
Pharmacy Address
PLAINS REGIONAL MEDICAL CENTER PHARMACY
2401 W. 21ST ST
CLOVIS, NM 88101
Pharmacy Comments
Contract Details
Approval Date
10/23/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DALE MAXWELL, SENIOR VP & CFO
(505) 923-5353
Contract Pharmacy Representative
Amy Kelley, Pharmacy Superviser
(575) 769-7680
Signed By Date
10/23/2014
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