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WAL-MART PHARMACY 10-1306
CAH321306-00 LINCOLN COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
LINCOLN COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH321306-00
Entity Address
211 SUDDERTH
RUIDOSO, NM 88345
Medicare Provider Number
321306
Participating Start Date
1/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1306
Pharmacy Address
233 S NEW YORK AVENUE
ALAMOGORDO, NM 88310
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DALE MAXWELL, SENIOR VP & CFO
(505) 923-5353
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2014
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