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WAL-MART PHARMACY 10-0831
CHC08229-00 FIRST NATIONS COMMUNITY HEALTH SOURCE INC
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Covered Entity Details
Entity Name
FIRST NATIONS COMMUNITY HEALTH SOURCE INC
Subdivision Name
First Nations Community HealthSource
Type
HRSA-Funded Health Center
340B ID
CHC08229-00
Entity Address
5608 Zuni Rd SE
Albuquerque, NM 87108-2926
Grant Number
H80CS08229
Participating Start Date
1/1/2015
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0831
Pharmacy Address
301 SAN MATEO BLV SE
ALBUQUERQUE, NM 87108
Pharmacy Comments
Contract Details
Approval Date
11/25/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/3/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Linda Son-Stone, CEO
(505) 262-6546
Contract Pharmacy Representative
Misty Jackson, Pharmacy Director
(505) 262-1915
Signed By Date
11/25/2014
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