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WAL-MART PHARMACY 10-2451
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
WAL-MART PHARMACY 10-2451
Pharmacy Address
4700 CUTLER AVE NE
ALBUQUERQUE, NM 87110
Pharmacy Comments
Contract Details
Approval Date
1/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ella B. Watt, CFO
(505) 272-1840
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/4/2016
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