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WAL-MART PHARMACY 10-0549
CAH321305-03 NOR-LEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
NOR-LEA GENERAL HOSPITAL
Subdivision Name
TATUM CLINIC
Type
Critical Access Hospital
340B ID
CAH321305-03
Entity Address
204 N. MAIN STREET
TATUM, NM 88267
Medicare Provider Number
321305
Outpatient Facility Provider Number
323984
Participating Start Date
9/24/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0549
Pharmacy Address
3800 NO. LOVINGTON HWY.
HOBBS, NM 88240
Pharmacy Comments
Contract Details
Approval Date
10/5/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Shaw, CEO
(575) 396-6611 Ext: 1102
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/5/2015
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