Covered Entity Details

CH062797F AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED (Approved) - information as of 5/2/2025 10:28:34 PM

Main Details

Name

AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED

Subdivision Name

Calderon Clinic Robstown

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039786

340B ID

CH062797F

Grant Number

H80CS08778

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/9/2025

Last Recertification Date

Contacts

Authorizing Official

Amistad Community Health Center
Eric Baggerman, CEO
(361) 960-9052

Primary Contact

Amistad Community Health Center Inc
Leo Trevino, Staff Accountant
(361) 886-3033

Addresses

Street Address

710 E Main Ave
Robstown, TX 78380-3133

Billing Address

Amistad Community Health Center
1533 S Brownlee Blvd
Corpus Christi, TX 78404

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
CH0627970	Active	BPS-H80-003511	AMISTAD COMMUNITY HEALTH CENTER	AMISTAD COMMUNITY HEALTH CENTER	1533 S Brownlee Blvd	Corpus Christi	TX
CH062797A	Active	BPS-H80-030221	AMISTAD COMMUNITY HEALTH CENTER.	Amistad Community Health Center	814 E Main Ave	Robstown	TX
CH062797B	Active	BPS-H80-033572	AMISTAD COMMUNITY HEALTH CENTER.	Amistad Community Health Center - Aransas Pass	1711 W Wheeler Ave Ste 1	Aransas Pass	TX
CH062797C	Active	BPS-H80-032887	AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED	Amistad Community Health Center Mobile Unit	1533 S Brownlee Blvd	Corpus Christi	TX
CH062797D	Active	BPS-H80-038266	AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED	Gloria Hicks Elementary School	3602 McArdle Rd RM WRm2	Corpus Christi	TX
CH062797E	Active	BPS-H80-039212	AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED	Amistad Health Aransas Pass Suite 3	1711 W Wheeler Ave STE 3	Aransas Pass	TX
CH062797F	Approved	BPS-H80-039786	AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED	Calderon Clinic Robstown	710 E Main Ave	Robstown	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0627970	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2024
CH0627970	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2024
CH0627970	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2024
CH0627970	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2024
CH0627970	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2024
CH0627970	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2024
CH0627970	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2025
CH0627970	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2025
CH0627970	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2025
CH0627970	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2025
CH0627970	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2025
CH0627970	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2025
CH0627970	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2025
CH0627970	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2025
CH0627970	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2025
CH0627970	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2025
CH0627970	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2025
CH0627970	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	04/01/2016	07/01/2024
CH0627970	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/01/2016	07/01/2024
CH0627970	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022
CH0627970	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2022
CH0627970	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 2328	3205 S. ALAMEDA STREET	CORPUS CHRISTI	TX	78404	10/01/2019
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06986	1240 SOUTH PORT AVE	CORPUS CHRISTI	TX	78405	10/01/2019	07/04/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06989	4102 AYERS ST	CORPUS CHRISTI	TX	78415	10/01/2019	08/25/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06991	4166 S STAPLES ST	CORPUS CHRISTI	TX	78411	10/01/2019
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02580	7442 S. STAPLES ST.	CORPUS CHRISTI	TX	78413	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06992	4801 S ALAMEDA ST	CORPUS CHRISTI	TX	78412	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07080	1000 NORTH FIRST STREET	ROBSTOWN	TX	78380	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07401	4101 IH 69 ACCESS ROAD SUITE C	CORPUS CHRISTI	TX	78410	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07437	2102 AIRLINE RD	CORPUS CHRISTI	TX	78414	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07471	14525 S. PADRE ISLAND DR.	CORPUS CHRISTI	TX	78418	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10262	7798 SO. PADRE ISLAND DR.	CORPUS CHRISTI	TX	78412	01/01/2022
CH0627970	CVS PHARMACY, INC.	CVS/PHARMACY # 10667	111 EAST HIDALGO ST	RAYMONDVILLE	TX	78580	01/01/2022
CH0627970	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10840	213 EAST SAN PATRICIO AVE.	MATHIS	TX	78368	01/01/2022
CH0627970	CVS PHARMACY, INC.	CVS PHARMACY # 16322	7608 NE ZAC LENTZ PKWY	VICTORIA	TX	77904	01/01/2022
CH0627970	CVS PHARMACY, INC.	CVS/PHARMACY # 6896	11950 MASON RD.	RICHMOND	TX	77469	10/01/2022
CH0627970	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2025
CH0627970	DE LEON'S PHARMACY, INC.	613 ELIZABETH STREET	SUITE 103	CORPUS CHRISTI	TX	78404	07/01/2014	07/01/2024
CH0627970	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2024
CH0627970	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2024
CH0627970	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2024
CH0627970	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2024
CH0627970	GENOA HEALTHCARE LLC	1546 S BROWNLEE BLVD RM 1102		CORPUS CHRISTI	TX	78404	10/01/2022
CH0627970	GENOA HEALTHCARE LLC	9200 HEMPSTEAD RD STE 150 BLDG D		HOUSTON	TX	77008	10/01/2022	07/01/2024
CH0627970	GENOA HEALTHCARE LLC	850 HARRISON STREET, ROOM 230		WARSAW	IN	46580-3163	01/01/2023
CH0627970	GENOA HEALTHCARE LLC	233 SGT. ED HOLCOMB BLVD SOUTH, STE 100		CONROE	TX	77304	10/01/2024
CH0627970	H-E-B, LP	H-E-B PHARMACY WAREHOUSE	6520 FRATT RD	SAN ANTONIO	TX	78218	10/01/2018	07/01/2024
CH0627970	HEB PHARMACY #057	1145 WALDRON		CORPUS CHRISTI	TX	78418	07/01/2019
CH0627970	HEB PHARMACY #184	11158 LEOPARD ST		CORPUS CHRISTI	TX	78410	07/01/2019
CH0627970	HEB PHARMACY #210	4320 S ALAMEDA		CORPUS CHRISTI	TX	78412	07/01/2019
CH0627970	HEB PHARMACY #253	3500 LEOPARD ST.		CORPUS CHRISTI	TX	78408	10/01/2018
CH0627970	HEB PHARMACY #270	5425 S. PADRE ISLAND DR		CORPUS CHRISTI	TX	78411	07/01/2019
CH0627970	HEB PHARMACY #413	3133 SOUTH ALAMEDA		CORPUS CHRISTI	TX	78404	10/01/2018
CH0627970	HEB PHARMACY #462	3033 S PORT ST		CORPUS CHRISTI	TX	78405	10/01/2018
CH0627970	HEB PHARMACY #643	4444 KOSTORYZ		CORPUS CHRISTI	TX	78415	10/01/2018
CH0627970	HEB PHARMACY WAREHOUSE 208	H-E-B, LP	5311 DIETRICH RD STE 100	SAN ANTONIO	TX	78219	07/07/2023
CH0627970	HEB SPECIALTY PHARMACY #701	3503 FREDERICKSBURG RD	STE 450	SAN ANTONIO	TX	78201	10/01/2023
CH0627970	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CH0627970	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/01/2024
CH0627970	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2025
CH0627970	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2025
CH0627970	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2025
CH0627970	SHORELINE PHARMACY	DMB HEALTH AT CORPUS LLC	1311 S STAPLES ST	CORPUS CHRISTI	TX	78404	10/01/2022	07/01/2024
CH0627970	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH0627970	WAL-MART PHARMACY 10-0464	3829 U.S. HWY. 77		CORPUS CHRISTI	TX	78410	04/01/2025
CH0627970	WAL-MART PHARMACY 10-0470	1821 S. PADRE ISLAND DR		CORPUS CHRISTI (NW)	TX	78416	07/01/2016
CH0627970	WAL-MART PHARMACY 10-1494	4109 S STAPLES STREET		CORPUS CHRISTI	TX	78411	07/01/2016
CH0627970	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH0627970	WALGREEN CO.	DBA: WALGREENS # 03639	2101 MORGAN AVENUE	CORPUS CHRISTI	TX	78405	04/01/2015
CH0627970	WALGREEN CO.	DBA: WALGREENS # 04424	4501 AYERS STREET	CORPUS CHRISTI	TX	78415	04/01/2015
CH0627970	WALGREEN CO.	DBA: WALGREENS #10945	11133 LEOPARD ST.	CORPUS CHRISTI	TX	78410-2613	04/01/2015
CH0627970	WALGREEN CO.	DBA: WALGREENS #15931	4161 S. STAPLES ST	CORPUS CHRISTI	TX	78411	04/01/2015
CH0627970	WALGREEN CO.	DBA: WALGREENS # 03638	5601 SARATOGA BLVD	CORPUS CHRISTI	TX	78414	04/01/2016
CH0627970	WALGREEN CO.	DBA: WALGREENS # 03637	5702 WEBER ROAD	CORPUS CHRISTI	TX	78413	04/01/2016
CH0627970	WALGREEN CO.	DBA: WALGREENS # 10449	7153 S PADRE ISLAND DR	CORPUS CHRISTI	TX	78412-4913	04/01/2016
CH0627970	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15320	4101 GREENBRIAR DR STE 235	HOUSTON	TX	77098	04/01/2016
CH0627970	WALGREEN CO.	DBA: WALGREENS # 04744	1301 AIRLINE ROAD	CORPUS CHRISTI	TX	78412	04/01/2018	10/09/2023
CH0627970	WALGREEN CO.	DBA: WALGREENS #10680	2702 WEST WHEELER	ARANSAS PASS	TX	78336	04/01/2020
CH0627970	WALGREEN CO.	DBA: WALGREENS #16030	1105 US HWY 181	PORTLAND	TX	78374	04/01/2020
CH0627970	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	07/01/2023
CH0627970	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2015	06/17/2015
CH0627970	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2015	06/17/2015
CH0627970	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH0627970	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		Baggerman, Eric CEO Amistad Community Health Center 3619609052	4/9/2025 1:32 PM
Details	340B ID	Update	New Registration		CH062797F	4/9/2025 1:32 PM
Dates	Participating Approval Date	Update	New Registration		4/9/2025 1:32:22 PM	4/9/2025 1:32 PM
Details	State	Update	New Registration	Pending	Approved	4/9/2025 1:32 PM
Dates	Signed By Date	Update	New Registration		4/7/2025 3:01:19 PM	4/9/2025 1:32 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/9/2025 1:32 PM
Addresses	Main Address	Insert	New Registration		710 E Main Ave Robstown, TX 78380-3133	4/7/2025 3:01 PM
Addresses	Billing Address	Insert	New Registration		Amistad Community Health Center 1533 S Brownlee Blvd Corpus Christi, TX 78404	4/7/2025 3:01 PM
Contacts	Primary Contact	Insert	New Registration		Trevino, Leo Staff Accountant Amistad Community Health Center Inc 3618863033	4/7/2025 3:01 PM
Contacts	Authorizing Official	Insert	New Registration		Baggerman, Eric CEO Amistad Community Health Center 3619609052	4/7/2025 3:01 PM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 3:01 PM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 3:01 PM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 3:01 PM
Details	Grant Number	Insert	New Registration		H80CS08778	4/7/2025 3:01 PM
Details	340B ID	Insert	New Registration			4/7/2025 3:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 3:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 3:01 PM
Details	Medicare Provider Number	Insert	New Registration			4/7/2025 3:01 PM
Details	Entity Name	Insert	New Registration		AMISTAD COMMUNITY HEALTH CENTER, INCORPORATED	4/7/2025 3:01 PM
Details	NOFO Number	Insert	New Registration			4/7/2025 3:01 PM
Details	Program Code	Insert	New Registration		CH	4/7/2025 3:01 PM
Details	Entity Subname	Insert	New Registration		Calderon Clinic Robstown	4/7/2025 3:01 PM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 3:01 PM
Details	State	Insert	New Registration		Pending	4/7/2025 3:01 PM
Dates	Registration Date	Insert	New Registration		4/7/2025 3:01:19 PM	4/7/2025 3:01 PM
Dates	Signed By Date	Insert	New Registration			4/7/2025 3:01 PM
Dates	Start Date	Insert	New Registration			4/7/2025 3:01 PM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 3:01 PM
Terminations	Termination Date	Insert	New Registration			4/7/2025 3:01 PM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 3:01 PM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 3:01 PM

340B Drug Pricing Program Database