340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-2656

Pharmacy Address

1610 N RIVERSIDE DRIVE
ESPANOLA, NM 87532

Pharmacy Comments

Approval Date

1/14/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

DALE MAXWELL, SENIOR VP & CFO
(505) 923-5353

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

1/14/2014