340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-2270
CAH061328-00 UPPER SAN JUAN HEALTH SERVICE DISTRICT
Print
Covered Entity Details
Entity Name
UPPER SAN JUAN HEALTH SERVICE DISTRICT
Subdivision Name
PAGOSA SPRINGS MEDICAL CENTER
Type
Critical Access Hospital
340B ID
CAH061328-00
Entity Address
95 SOUTH PAGOSA BLVD
PAGOSA SPRINGS, CO 81147
Medicare Provider Number
061328
Participating Start Date
4/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2270
Pharmacy Address
1155 SOUTH CAMINO DEL RIO
DURANGO, CO 81303
Pharmacy Comments
Contract Details
Approval Date
4/20/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Johna Lederhouse, Controller
(970) 507-3760
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/20/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session