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WALGREENS SPECIALTY PHARMACY, LLC
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
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/6/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2018
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