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SMITH'S PHARMACY
DSH320001 UNIVERSITY OF NEW MEXICO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF NEW MEXICO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320001
Entity Address
2211 Lomas Blvd NE
ALBUQUERQUE, NM 87106
Medicare Provider Number
320001
Participating Start Date
9/1/1993
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY
Pharmacy Address
02-B HIGHWAY 344
EDGEWOOD, NM 87015
Pharmacy Comments
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ella B. Watt, CFO
(505) 272-1840
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/29/2013
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