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MJRX, LLC DBA RX INNOVATIONS
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
MJRX, LLC DBA RX INNOVATIONS
Pharmacy Address
7209 JEFFERSON ST NE
ALBUQUERQUE, NM 87109
Pharmacy Comments
Contract Details
Approval Date
7/8/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ella B. Watt, CFO
(505) 272-1840
Contract Pharmacy Representative
Martin Salas, Owner
(505) 881-4601
Signed By Date
7/8/2015
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