Covered Entity Details

CH06074N UNITED MEDICAL CENTERS (Approved) - information as of 5/1/2025 11:46:39 PM

Main Details

Name

UNITED MEDICAL CENTERS

Subdivision Name

Northside Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039059

340B ID

CH06074N

Grant Number

H80CS00643

Additional Details

Current Program Status

Approved

Registration Date

4/1/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/2/2025

Last Recertification Date

Contacts

Authorizing Official

United Medical Centers
William Worrell, Chief Executive Officer
(830) 773-8917

Primary Contact

United Medical Centers
Michael Luna, Pharmacy Director
(830) 872-3140

Addresses

Street Address

3809 Veterans Blvd
Del Rio, TX 78840-2860

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH060740	Active	BPS-H80-002150	United Medical Centers	United Medical Centers Inc.	2525 N Veterans Blvd	Eagle Pass	TX
CH06074D	Active	BPS-H80-004439	United Medical Centers	UNITED MEDICAL CENTERS #3	913 S Main St	Del Rio	TX
CH06074E	Active	BPS-H80-000291	United Medical Centers	San Felipe Clinic	1117 W De La Rosa St	Del Rio	TX
CH06074F	Active	BPS-H80-009593	United Medical Centers	Bedell Avenue Clinic	2209 N Bedell Ave	Del Rio	TX
CH06074G	Active	BPS-H80-000625	United Medical Centers	Eidson Road Clinic	1175 Eidson Rd	Eagle Pass	TX
CH06074H	Active	BPS-H80-011388	United Medical Centers	El Indio Hwy Clinic	4018 FM 1021 (El Indio Hwy.)	Eagle Pass	TX
CH06074J	Active	BPS-H80-000663	United Medical Centers	UNITED MEDICAL CENTERS # 2	202 JAMES STREET	BRACKETTVILLE	TX
CH06074K	Terminated	BPS-H80-012873	United Medical Centers	UNITED MEDICAL CENTERS #2	201 JAMES STREET	BRACKETTVILLE	TX
CH06074L	Active	BPS-H80-027694	United Medical Centers	East Academy Clinic	119 E Academy St	Del Rio	TX
CH06074M	Active	BPS-H80-033780	United Medical Centers	Women's Health Center	2525 N Veterans Blvd Bldg 2	Eagle Pass	TX
CH06074N	Approved	BPS-H80-039059	UNITED MEDICAL CENTERS	Northside Clinic	3809 Veterans Blvd	Del Rio	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH060740	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/01/2017
CH060740	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018
CH060740	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	04/01/2018	01/10/2024
CH060740	AVITA PHARMACY 1031	PHARMBLUE HOLDINGS LLC D/B/A AVITA PHARM	1495 N 7TH ST STE B	BEAUMONT	TX	77702-1345	01/01/2020
CH060740	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	01/01/2020
CH060740	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH060740	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2020	01/10/2024
CH060740	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2020
CH06074J	CLINIC PHARMACY	BRACKETTVILLE PHARMACY, LLC	201 JAMES ST, U 1378	BRACKETTVILLE	TX	78832-5117	04/01/2020
CH060740	CLINIC PHARMACY	BRACKETTVILLE PHARMACY, LLC	201 JAMES ST, U 1378	BRACKETTVILLE	TX	78832-5117	04/01/2020
CH060740	CVS PHARMACY, INC.	CVS/PHARMACY # 10356	409 VETERANS BOULEVARD	DEL RIO	TX	78840	07/01/2023
CH060740	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	01/01/2018	11/23/2020
CH060740	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	01/01/2020
CH060740	FRIENDLY PHARMACY	2176 E GARRISON ST STE D		EAGLE PASS	TX	78852-5072	01/01/2015	01/31/2020
CH060740	H-E-B, LP	H-E-B PHARMACY WAREHOUSE	6520 FRATT RD	SAN ANTONIO	TX	78218	10/01/2018
CH060740	HEB PHARMACY #418	200 VETERANS BLVD		DEL RIO	TX	78840	10/01/2018
CH060740	HEB PHARMACY #419	2135 E. MAIN STREET		EAGLE PASS	TX	78852	10/01/2018
CH060740	HEB PHARMACY WAREHOUSE 208	H-E-B, LP	5311 DIETRICH RD STE 100	SAN ANTONIO	TX	78219	07/11/2023
CH060740	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	04/01/2018
CH060740	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH060740	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/01/2020
CH060740	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/01/2020
CH060740	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH060740	WAL-MART PHARMACY 10-0447	2410 DODSON STREET		DEL RIO	TX	78840	10/01/2015
CH060740	WAL-MART PHARMACY 10-0461	496 SOUTH BIBB STREET		EAGLE PASS	TX	78852	10/01/2015
CH060740	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH060740	WALGREEN CO.	DBA: WALGREENS #15993	2341 E MAIN ST	EAGLE PASS	TX	78852	04/01/2019
CH060740	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	07/01/2023
CH060740	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH060740	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Worrell, William Chief Executive Officer United Medical Centers 8307738917	4/2/2025 8:28 AM
Details	340B ID	Update	New Registration		CH06074N	4/2/2025 8:28 AM
Dates	Participating Approval Date	Update	New Registration		4/2/2025 8:28:41 AM	4/2/2025 8:28 AM
Details	State	Update	New Registration	Pending	Approved	4/2/2025 8:28 AM
Dates	Signed By Date	Update	New Registration		4/1/2025 3:07:42 PM	4/2/2025 8:28 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/2/2025 8:28 AM
Addresses	Main Address	Insert	New Registration		3809 Veterans Blvd Del Rio, TX 78840-2860	4/1/2025 3:07 PM
Contacts	Primary Contact	Insert	New Registration		Luna, Michael Pharmacy Director United Medical Centers 8308723140	4/1/2025 3:07 PM
Contacts	Authorizing Official	Insert	New Registration		Worrell, William Chief Executive Officer United Medical Centers 8307738917	4/1/2025 3:07 PM
Details	Assistance Received From Date	Insert	New Registration			4/1/2025 3:07 PM
Details	Assistance Received To Date	Insert	New Registration			4/1/2025 3:07 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2025 3:07 PM
Details	Grant Number	Insert	New Registration		H80CS00643	4/1/2025 3:07 PM
Details	340B ID	Insert	New Registration			4/1/2025 3:07 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2025 3:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2025 3:07 PM
Details	Medicare Provider Number	Insert	New Registration			4/1/2025 3:07 PM
Details	Entity Name	Insert	New Registration		UNITED MEDICAL CENTERS	4/1/2025 3:07 PM
Details	NOFO Number	Insert	New Registration			4/1/2025 3:07 PM
Details	Program Code	Insert	New Registration		CH	4/1/2025 3:07 PM
Details	Entity Subname	Insert	New Registration		Northside Clinic	4/1/2025 3:07 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2025 3:07 PM
Details	State	Insert	New Registration		Pending	4/1/2025 3:07 PM
Dates	Registration Date	Insert	New Registration		4/1/2025 3:07:41 PM	4/1/2025 3:07 PM
Dates	Signed By Date	Insert	New Registration			4/1/2025 3:07 PM
Dates	Start Date	Insert	New Registration			4/1/2025 3:07 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2025 3:07 PM
Terminations	Termination Date	Insert	New Registration			4/1/2025 3:07 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2025 3:07 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2025 3:07 PM

340B Drug Pricing Program Database