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WAL-MART CENTRAL FILL 10-2670
DSH320004 CHRISTUS Southern New Mexico
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Covered Entity Details
Entity Name
CHRISTUS Southern New Mexico
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320004
Entity Address
2669 SCENIC DR
ALAMOGORDO, NM 88310-8734
Medicare Provider Number
320004
Participating Start Date
4/1/2015
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
3/26/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
3/26/2015
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