340B Drug Pricing Program Database


CH06325E El Centro Del Barrio (Terminated) - information as of 4/23/2025 10:51:04 PM

Main Details
El Centro Del Barrio
CENTROMED SAN ANTONIO STREET CLINIC
HRSA-Funded Health Center
BPS-H80-008428
CH06325E
H80CS00758


Additional Details
Terminated
1/1/2005
1/1/2005
11/19/2004
3/1/2016

4/1/2017
Site closure

Contacts

CemrtoMed
Ernesto Gomez, President / CEO
(210) 334-3703

CentroMed
Don Macaulay, VP / Chief Operating Officer
(210) 334-3705

Addresses

1614 San Antonio Street
New Braunfels, TX 78130-6273

El Centro del Barrio dba CentroMed
3750 Commercial Ave
San Antonio, TX 78221


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
NEW SITE 01/01/200511/19/2004
Medicaid Billing

No
Shipping Addresses

CentroMed Pharmacy
918 Wagner
San Antonio, TX 78211
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH063250ActiveBPS-H80-008146El Centro Del BarrioCentroMed Southside Medical Clinic3750 Commercial Ave San AntonioTX
CH06325AActiveBPS-H80-002475El Centro Del BarrioCENTROMED SOUTH PARK MEDICAL CLINIC6315 S Zarzamora St San AntonioTX
CH06325AAActiveBPS-H80-023383El Centro Del BarrioCENTROMED FAMILY MEDICINE CLINIC226 North Union Avenue New BraunfelsTX
CH06325ABActiveBPS-H80-026012El Centro Del BarrioCENTROMED FAMILY FIRST CLINIC9135 Schaefer Road ConverseTX
CH06325ACActiveBPS-H80-028115El Centro Del BarrioCentroMed SA Pediatrics9793 Culebra Rd San AntonioTX
CH06325ADActiveBPS-H80-028116El Centro Del BarrioCentroMed SA Pediatrics17323 Interstate 35 N SchertzTX
CH06325AETerminatedBPS-H80-028114El Centro Del BarrioCentroMed SA Pediatrics730 N Main Ave Ste 224 San AntonioTX
CH06325AFTerminatedBPS-H80-028112El Centro Del BarrioCentroMed SA Pediatrics20627 Huebner Hills Road A101 San AntonioTX
CH06325AGTerminatedBPS-H80-028391El Centro Del BarrioCentroMed SA Pediatrics7333 Barlite Blvd Ste 380 San AntonioTX
CH06325AHTerminatedBPS-H80-028113El Centro Del BarrioCentroMed SA Pediatrics315 N San Saba San AntonioTX
CH06325AJActiveBPS-H80-034756EL CENTRO DEL BARRIOCentroMed SA Pediatrics3327 Research Plaza San AntonioTX
CH06325AKActiveBPS-H80-034775EL CENTRO DEL BARRIOCentroMed SA Pediatrics94 Briggs St San AntonioTX
CH06325ALActiveBPS-H80-034776EL CENTRO DEL BARRIOCentroMed SA Pediatrics123 Stone Oak Loop San AntonioTX
CH06325AMActiveBPS-H80-034777EL CENTRO DEL BARRIOCentroMed SA Pediatrics580 Cibolo Valley Dr CiboloTX
CH06325ANTerminatedBPS-H80-034778EL CENTRO DEL BARRIOCentroMed SA Pediatrics9150 Huebner Rd San AntonioTX
CH06325APActiveBPS-H80-036199EL CENTRO DEL BARRIOCentroMed - Lifetime Recovery10290 Southton RoadBuilding 4San AntonioTX
CH06325AQActiveBPS-H80-038459EL CENTRO DEL BARRIOCentroMed Women's Health Clinic7386 Barlite Blvd San AntonioTX
CH06325ARActiveBPS-H80-038723EL CENTRO DEL BARRIOCentroMed SA Pediatrics1314 Guadalupe St San AntonioTX
CH06325ASActiveBPS-H80-033733EL CENTRO DEL BARRIOCentroMed City Center Clinic207 E Evergreen St San AntonioTX
CH06325CActiveBPS-H80-008429El Centro Del BarrioCENTROMED SA PEDIATRICS1034 W County Line Rd New BraunfelsTX
CH06325DActiveBPS-H80-002250El Centro Del BarrioCENTROMED MARIA CASTRO FLORES CLINIC7315 SOUTH LOOP 1604 WEST SOMERSETTX
CH06325ETerminatedBPS-H80-008428El Centro Del BarrioCENTROMED SAN ANTONIO STREET CLINIC1614 San Antonio Street New BraunfelsTX
CH06325FActiveBPS-H80-011884El Centro Del BarrioCentroMed Noemi Galvan Eling Clinic5542 Walzem Rd San AntonioTX
CH06325GActiveBPS-H80-003530El Centro Del BarrioCENTROMED WOMEN'S SHELTER CLINIC - LA PALOMA DE PAZ7404 W US HIGHWAY 90BUILDING 37SAN ANTONIOTX
CH06325HTerminatedBPS-H80-007936El Centro Del BarrioCentroMed Santa Rosa Clinic/Ryan White Clinic315 N. SAN SABA SAN ANTONIOTX
CH06325KTerminatedBPS-H80-001369El Centro Del BarrioCENTROMED SW MILITARY DRIVE WIC910 SW Military Dr San AntonioTX
CH06325LActiveBPS-H80-001822El Centro Del BarrioCENTROMED SOUTH PARK DENTAL CLINIC910 Wagner Ave San AntonioTX
CH06325MTerminatedBPS-H80-005364El Centro Del BarrioCENTROMED RESIDENTIAL TREATMENT CENTER CLINIC4040 High Ridge Cir San AntonioTX
CH06325QTerminatedBPS-H80-000245El Centro Del BarrioCENTROMED CHILDREN'S SHELTER CLINIC2939 W WOODLAWN SAN ANTONIOTX
CH06325RTerminatedBPS-H80-003614El Centro Del BarrioCENTROMED RESPITE CARE SHELTER CLINIC605 Belknap Pl San AntonioTX
CH06325STerminatedBPS-H80-001490El Centro Del BarrioCENTROMED RESPITE DAY CARE510 Belknap Pl San AntonioTX
CH06325UActiveBPS-H80-002742El Centro Del BarrioCENTROMED PALO ALTO CLINIC9011 Poteet Jourdanton Fwy San AntonioTX
CH06325VTerminatedBPS-H80-009213El Centro Del BarrioCENTROMED HOUSE OF HOPE CLINIC256 S Krueger Ave New BraunfelsTX
CH06325WActiveBPS-H80-008185El Centro Del BarrioCENTROMED SARAH E DAVIDSON CLINIC1 Haven for Hope WayBuilding 1San AntonioTX
CH06325XTerminatedBPS-H80-010952El Centro Del BarrioCENTROMED CITY BASE CLINIC3127 SE MILITARY STE 101 SAN ANTONIOTX
CH06325YTerminatedBPS-H80-017368EL CENTRO DEL BARRIOCENTROMED MEDINA BASE CLINIC5750 Medina Base Road San AntonioTX
CH06325ZActiveBPS-H80-019431El Centro Del BarrioCENTROMED BERTO GUERRA JR CLINIC5439 Ray Ellison Boulevard San AntonioTX
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH063250ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280910/01/2024  
CH063250AETNA SPECIALTY PHARMACY, LLC503 SUNPORT LN
ORLANDOFL32809-787407/01/2019 01/14/2022
CH063250AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10315 N. SAN SABA STE. 110
SAN ANTONIOTX7820706/14/2023  
CH063250AVITA DRUGS, LLC D/B/A AVITA PHARMACY 102602 N MAIN AVE
SAN ANTONIOTX7821206/14/2023  
CH063250AVITA DRUGS, LLC D/B/A AVITA PHARMACY 106406 MCPHERSON RD STE 6
LAREDOTX7804101/01/2024  
CH06325AAVITA DRUGS, LLC D/B/A AVITA PHARMACY 10315 N. SAN SABA STE. 110
SAN ANTONIOTX7820710/01/2024  
CH06325AAAVITA DRUGS, LLC D/B/A AVITA PHARMACY 102602 N MAIN AVE
SAN ANTONIOTX7821210/01/2024  
CH063250AVITA PHARMACY 1029340B PARTNERS PHARMACY LLC D/B/A AVITA P 303 N FRIO ST
SUITE 102 		SAN ANTONIOTX78207-303401/01/2024  
CH06325ALAVITA PHARMACY 1029340B PARTNERS PHARMACY LLC D/B/A AVITA P 303 N FRIO ST
SUITE 102 		SAN ANTONIOTX78207-303410/01/2024  
CH063250AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080801/01/2024  
CH063250BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2019  
CH063250CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2021  
CH063250CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2019  
CH063250CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2019  
CH063250CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2021  
CH063250CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2021  
CH063250CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2019  
CH063250CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2021  
CH063250CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2021  
CH063250CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2021  
CH063250CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2021  
CH063250CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021  
CH063250CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10843 19244 MCDONALD ST.
LYTLETX7805207/01/2019  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07716 1836 PAT BOOKER RD
UNIVERSAL CITYTX7814807/01/2019  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 05512 7208 FM 78
SAN ANTONIOTX7824407/01/2019  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 6955 8027 KITTY HAWK
CONVERSETX7810907/01/2019  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10597 8731 POTEET JOURDANTON FREEWAY
SAN ANTONIOTX7822407/01/2019  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10051 2920 EAST SOUTHCROSS BLVD.
SAN ANTONIOTX7821107/01/2019  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07307 2018 CULEBRA ROAD
SAN ANTONIOTX7820107/01/2019  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07303 5506 WALZEM RD
SAN ANTONIOTX7821807/01/2019 02/01/2023
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07551 2801 NOGALITOS
SAN ANTONIOTX7822507/01/2019 06/05/2023
CH063250CVS PHARMACY, INC.CVS PHARMACY # 16238 2810 SW MILITARY DR
SAN ANTONIOTX7822407/01/2019  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07403 103 S.W. MILITARY DR.
SAN ANTONIOTX7822107/01/2019  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10141 5975 OLD PEARSALL RD.
SAN ANTONIOTX7824207/01/2019  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 01201 4730 FREDRICKSBURG RD.
SAN ANTONIOTX7822901/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07831 6539 DE ZAVALA RD
SAN ANTONIOTX7824901/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07808 4805 MEDICAL DR
SAN ANTONIOTX7822901/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07299 7202 SAN PEDRO
SAN ANTONIOTX7821601/01/2020 09/15/2022
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10264 1118 SOUTH WW WHITE RD.
SAN ANTONIOTX7822001/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 02263 22202 BULVERDE RD.
SAN ANTONIOTX7826104/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 5858 15038 NACOGDOCHES RD.
SAN ANTONIOTX7824704/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10844 9014 NORTH STATE HWY 16
POTEETTX7806504/01/2020 02/04/2020
CH063250CVS PHARMACY, INC.CVS PHARMACY # 16972 3227 SE MILITARY DR
SAN ANTONIOTX7822304/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07725 343 W HOUSTON ST STE 106
SAN ANTONIOTX7820504/01/2020 06/23/2022
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07306 6915 W AVE
CASTLE HILLSTX7821304/01/2020  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 17645 1223 AUSTIN HWY
SAN ANTONIOTX7820904/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 05857 7603 CULEBRA
SAN ANTONIOTX7825104/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07832 9838 POTRANCO RD
SAN ANTONIOTX7825104/01/2020  
CH063250CVS PHARMACY, INC.CVS/PHARMACY # 10179 300 EAST COMMERCE ST.
SAN ANTONIOTX7820504/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10347 9686 MARBACH ROAD
SAN ANTONIOTX7824504/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 08389 8602 HUEBNER RD
SAN ANTONIOTX7824004/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07301 3027 NACOGDOCHES RD
SAN ANTONIOTX7821704/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07724 10225 WURZBACH RD
SAN ANTONIOTX7823007/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 7000 5301 ALAMO PARKWAY
SAN ANTONIOTX7825307/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 01057 9140 GUILBEAU
SAN ANTONIOTX7825007/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07816 2693 FM 3009
SCHERTZTX7815407/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10485 919 WURZBACH PKWY
SAN ANTONIOTX7823107/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07829 16580 HUEBNER RD
SAN ANTONIOTX7824807/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07460 14900 JONES MALTSBERGER RD
SAN ANTONIOTX7824707/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 2391 15607 CHASE HILL BLVD.
SAN ANTONIOTX7825607/01/2020  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 17095 8223 STATE HIGHWAY 151
SAN ANTONIOTX7824507/01/2020  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 17483 5355 W LOOP 1604 N
SAN ANTONIOTX7825307/01/2020  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 16853 4522 FREDERICKSBURG RD
BALCONES HEIGHTSTX7820107/01/2020  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 17518 746 NW LOOP 410
SAN ANTONIOTX7821607/01/2020  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 5872 22135 IH-10 W
SAN ANTONIOTX7825707/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07341 9285 CULEBRA AVE
SAN ANTONIOTX7825107/01/2020  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 02580 7442 S. STAPLES ST.
CORPUS CHRISTITX7841301/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07417 11820 ELAM RD
BALCH SPRINGSTX7518001/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 06892 2402 GUADALUPE ST, UNIT B
AUSTINTX7870501/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10842 744 US HWY 181 NORTH
FLORESVILLETX7811401/01/2021  
CH063250CVS PHARMACY, INC.CVS/PHARMACY # 4880 805 W. BUSINESS HWY 380
DECATURTX7623401/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 4109 12835 POTRANCO RD
SAN ANTONIOTX7825301/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 08978 20203 STONE OAK PKWY.
SAN ANTONIOTX7825801/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 00357 1701 E. PARMER LN.
AUSTINTX7875401/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 5647 4101 EAST 42ND ST.
ODESSATX7976201/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10403 8049 FM 2673
CANYON LAKETX7813307/01/2021  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 17486 135 CREEKSIDE WAY
NEW BRAUNFELSTX7813007/01/2021  
CH063250CVS PHARMACY, INC.CVS/PHARMACY #10947 1910 STATE HIGHWAY 46 W
NEW BRAUNFELSTX7813207/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 08990 12980 BANDERA RD
HELOTESTX7802307/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10579 4600 BROADWAY STREET
ALAMO HEIGHTSTX7820907/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 10311 2502 MARSHALL RD.
SAN ANTONIOTX7825907/01/2021 02/28/2023
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 08386 4100 DE ZAVALA RD
SAN ANTONIOTX7824907/01/2021 10/17/2023
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 03894 120 E. SONTERRA BLVD.
SAN ANTONIOTX7825807/01/2021  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 16038 13700 SAN PEDRO AVE
SAN ANTONIOTX7823207/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10750 9050 FM 1560 N
SAN ANTONIOTX7825407/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07784 110 S KING ST
SEGUINTX7815507/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10905 13343 CULEBRA ROAD
SAN ANTONIOTX7825307/01/2021  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 16908 11311 BANDERA RD
SAN ANTONIOTX7825007/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 08325 19202 BLANCO RD
SAN ANTONIOTX7825807/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07207 210 NORTH BUSINESS IH 35
NEW BRAUNFELSTX7813007/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10633 3502 SE MILITARY DR.
SAN ANTONIOTX7822307/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07309 6470 N NEW BRAUNFELS AVE
SAN ANTONIOTX7820907/01/2021  
CH063250CVS PHARMACY, INC.CVS/PHARMACY # 10356 409 VETERANS BOULEVARD
DEL RIOTX7884007/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07728 112 MAIN ST
KERRVILLETX7802807/01/2021  
CH063250CVS PHARMACY, INC.CVS PHARMACY # 16559 8234 AGORA PKWY
SELMATX7815407/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #11328 1915 BROADWAY ST STE 101
SAN ANTONIOTX7821507/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #11045 5334 FM 1103
SCHERTZTX7810807/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10541 2020 S. WALNUT AVE.
NEW BRAUNFELSTX7813007/01/2021  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY # 7187 17307 BULVERDE RD.
SAN ANTONIOTX7824707/01/2021  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 05651 1602 EAST HIGHWAY 83
WESLACOTX7859604/01/2022  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07623 4610 FRANKFORD RD
DALLASTX7528704/01/2022  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 00248 2121 W. TRENTON RD.
EDINBURGTX7853904/01/2022  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10979 17900 WEST LAKE HOUSTON PARKWAY
HUMBLETX7734604/01/2022  
CH063250CVS PHARMACY, INC.DBA CVS/PHARMACY #10595 200 CIBOLO VALLEY DR.
CIBOLOTX7810810/01/2022  
CH063250CVS PHARMACY, INC.DBA: CVS/PHARMACY # 07428 8317 LOUETTA RD
SPRINGTX7737901/01/2023  
CH06325GCVS PHARMACY, INC.DBA CVS/PHARMACY #10347 9686 MARBACH ROAD
SAN ANTONIOTX7824510/01/2024  
CH06325ANCVS PHARMACY, INC.DBA CVS/PHARMACY #10597 8731 POTEET JOURDANTON FREEWAY
SAN ANTONIOTX7822410/01/2024 04/01/2025
CH06325WCVS PHARMACY, INC.DBA CVS/PHARMACY # 10141 5975 OLD PEARSALL RD.
SAN ANTONIOTX7824210/01/2024  
CH06325AJCVS PHARMACY, INC.DBA: CVS/PHARMACY # 05512 7208 FM 78
SAN ANTONIOTX7824410/01/2024  
CH06325DCVS PHARMACY, INC.CVS PHARMACY # 16238 2810 SW MILITARY DR
SAN ANTONIOTX7822410/01/2024  
CH06325FCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07403 103 S.W. MILITARY DR.
SAN ANTONIOTX7822110/01/2024  
CH063250CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2021  
CH063250CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2020  
CH063250DOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654001/01/2019  
CH063250EXACT CARE PHARMACYDDCRX, LLC 2701 HIGHPOINT OAKS DR STE 100
LEWISVILLETX75067-389604/01/2021 02/15/2023
CH063250EXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412504/01/2021 02/15/2023
CH063250H-E-B, LPH-E-B PHARMACY WAREHOUSE 6520 FRATT RD
SAN ANTONIOTX7821810/01/2019 07/13/2023
CH063250HEB PHARMACY #0846818 S. ZARZAMORA
SAN ANTONIOTX7822410/01/2019  
CH06325AKHEB PHARMACY #0846818 S. ZARZAMORA
SAN ANTONIOTX7822410/01/2024  
CH063250HEB PHARMACY #2946580 FM 78
SAN ANTONIOTX7824410/01/2019  
CH06325CHEB PHARMACY #2946580 FM 78
SAN ANTONIOTX7824410/01/2024  
CH063250HEB PHARMACY #3846030 MONTGOMERY RD
SAN ANTONIOTX7823910/01/2019  
CH06325AMHEB PHARMACY #3846030 MONTGOMERY RD
SAN ANTONIOTX7823910/01/2024  
CH063250HEB PHARMACY #427735 SW MILITARY DR
SAN ANTONIOTX7822110/01/2019  
CH06325APHEB PHARMACY #427735 SW MILITARY DR
SAN ANTONIOTX7822110/01/2024  
CH063250HEB PHARMACY #678302 VALLEY HI DR
SAN ANTONIOTX7822710/01/2019  
CH06325AHHEB PHARMACY #678302 VALLEY HI DR
SAN ANTONIOTX7822710/01/2024 04/01/2025
CH063250HEB Pharmacy #7016520 Fratt Road
San AntonioTX7821810/01/2019 07/13/2023
CH063250HEB PHARMACY WAREHOUSE 208H-E-B, LP 5311 DIETRICH RD STE 100
SAN ANTONIOTX7821907/13/2023  
CH063250HEB SPECIALTY PHARMACY #7013503 FREDERICKSBURG RD STE 450
SAN ANTONIOTX7820110/01/2020  
CH063250LAUREL HEIGHTS PHARMACY2602 N MAIN AVE
SAN ANTONIOTX7821201/01/2020 06/12/2023
CH063250LIFECARE GARZA PHARMACY4500 S PLEASANT VALLEY RD STE 100
AUSTINTX7874401/01/2020  
CH063250LIFECARE PHARMACY315 N. SAN SABA STE 110
SAN ANTONIOTX7820701/01/2020 06/12/2023
CH063250LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245301/01/2024  
CH063250PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/01/2020 10/07/2022
CH063250PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2019  
CH063250PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2859 7950 FLOYD CURL DR. STE #106
SAN ANTONIOTX7822904/01/2020  
CH063250PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2021  
CH063250PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681301/01/2021  
CH063250PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/01/2021  
CH063250RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/01/2019  
CH063250RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/01/2019  
CH063250WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2020  
CH063250WAL-MART PHARMACY 10-13131200 S.E. MILITARY DR
SAN ANTONIO (S)TX7821407/01/2019  
CH06325UWAL-MART PHARMACY 10-13131200 S.E. MILITARY DR
SAN ANTONIO (S)TX7821410/01/2024  
CH063250WAL-MART PHARMACY 10-31124096 N. FOSTER RD
SAN ANTONIOTX7824407/01/2019  
CH063250WAL-MART PHARMACY 10-51448315 FM 78
CONVERSETX7810907/01/2019  
CH06325ABWAL-MART PHARMACY 10-51448315 FM 78
CONVERSETX7810910/01/2024  
CH063250WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2020  
CH063250WALGREEN CO  710 OVILLA ROAD
WAXAHACHIETX7516703/05/2012 07/08/2015
CH063250WALGREEN CO.DBA: WALGREENS # 09394 1210 N IH35 BUSINESS LOOP
NEW BRAUNFELSTX7813011/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 10393 1610 STATE HWY 46 WEST
NEW BRAUNFELSTX78132-473711/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS #11928 5960 FM 1103
NEW BRAUNFELSTX7813211/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 06337 1160 S BUSINESS IH 35
NEW BRAUNFELSTX7813011/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 07939 9903 POTRANCO RD
SAN ANTONIOTX7825111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 09615 3030 GOLIAD RD
SAN ANTONIOTX78223-395911/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 02458 7802 WURZBACH ROAD
SAN ANTONIOTX7822911/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 09180 11103 W MILITARY DR
SAN ANTONIOTX7825111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 07371 7019 S ZARZAMORA ST
SAN ANTONIOTX78224-114111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 07571 10673 CULEBRA RD
SAN ANTONIOTX78251-134611/22/2011 11/11/2019
CH063250WALGREEN CO.DBA: WALGREENS #12479 121 N. ZARZAMORA ST.
SAN ANTONIOTX78207-373911/22/2011 11/14/2023
CH063250WALGREEN CO.DBA: WALGREENS #11276 502 NEW VALLEY HI
SAN ANTONIOTX7822711/22/2011  
CH063250WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21214 660 N MAIN AVE STE 101
SAN ANTONIOTX7820511/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03563 7103 MARBACH ROAD
SAN ANTONIOTX7822711/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03506 6363 RITTIMAN RD
SAN ANTONIOTX7821811/22/2011 05/07/2025
CH063250WALGREEN CO.DBA: WALGREENS # 03141 1105 GOLIAD ROAD
SAN ANTONIOTX7822311/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03140 410 W. CYPRESS ST.
SAN ANTONIOTX7821211/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03224 6901 SAN PEDRO AVE
SAN ANTONIOTX78216-620611/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 02943 2710 NOGALITOS
SAN ANTONIOTX7822511/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS #15461 1560 BANDERA ROAD
SAN ANTONIOTX7822811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03734 8202 CULEBRA RD
SAN ANTONIOTX7825111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03368 1581 AUSTIN HIGHWAY
SAN ANTONIOTX7821811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 02755 3065 RIGSBY AVE
SAN ANTONIOTX7822211/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03634 3326 FREDERICKSBURG ROAD
SAN ANTONIOTX7820111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 04552 4703 W. COMMERCE ST.
SAN ANTONIOTX7823711/22/2011 10/13/2016
CH063250WALGREEN CO.DBA: WALGREENS # 04160 2200 E. HOUSTON ST
SAN ANTONIOTX7820211/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03354 1106 CULEBRA
SAN ANTONIOTX7820111/22/2011 11/11/2019
CH063250WALGREEN CO.DBA: WALGREENS # 04934 6017 INGRAM ROAD
SAN ANTONIOTX7823811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03562 9080 MARBACH ROAD
SAN ANTONIOTX7824511/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03996 5760 WALZEM RD
WINDCRESTTX7821811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 05964 3401 SAN PEDRO
SAN ANTONIOTX7821211/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 06335 14025 NACOGDOCHES RD
SAN ANTONIOTX78247-191811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 05424 138 SW MILITARY DRIVE
SAN ANTONIOTX7822111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 01194 8530 FM 78
CONVERSETX7810911/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03083 10650 TOEPPERWEIN RD
CONVERSETX7810911/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS #13086 1944 S. SEGUIN AVE.
NEW BRAUNFELSTX7813011/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 07922 11658 IH 35 NORTH
SAN ANTONIOTX78233-530511/22/2011 10/14/2021
CH063250WALGREEN CO.DBA: WALGREENS # 07214 20800 US 281 NORTH
SAN ANTONIOTX7825811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 07923 22114 BULVERDE ROAD
SAN ANTONIOTX7825911/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 07308 4351 THOUSAND OAKS DRIVE
SAN ANTONIOTX78217-210111/22/2011 11/12/2019
CH063250WALGREEN CO.DBA: WALGREENS #12519 1902 N LOOP 1604 W
SAN ANTONIOTX7824811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS #12520 300 E. HOUSTON ST.
SAN ANTONIOTX78205-181611/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS #11520 13619 BABCOCK RD.
SAN ANTONIOTX7824911/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03504 6393 BABCOCK RD
SAN ANTONIOTX7824011/22/2011 01/22/2025
CH063250WALGREEN CO.DBA: WALGREENS #11971 20226 STONE OAK PKWY.
SAN ANTONIOTX7825811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03804 7655 TEZEL RD
SAN ANTONIOTX7825011/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 04274 2425 THOUSAND OAKS DRIVE
SAN ANTONIOTX7823211/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 04551 11707 HUEBNER ROAD
SAN ANTONIOTX7823011/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03505 6635 BANDERA RD
SAN ANTONIOTX7823811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 03571 14505 NW MILITARY HWY
SHAVANO PARKTX7823111/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 00662 13430 SAN PEDRO AVE
SAN ANTONIOTX7821611/22/2011 10/13/2016
CH063250WALGREEN CO.DBA: WALGREENS # 04374 10411 WEST AVENUE
SAN ANTONIOTX7821311/22/2011 05/07/2025
CH063250WALGREEN CO.DBA: WALGREENS # 04838 19203 STONE OAK PKWY
SAN ANTONIOTX7825811/22/2011  
CH063250WALGREEN CO.DBA: WALGREENS # 05963 3801 FM 3009
SCHERTZTX7815411/22/2011  
CH063250WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16485 7302 LOUIS PASTEUR DR STE 104
SAN ANTONIOTX7822901/01/2017  
CH063250WALGREEN CO.DBA: WALGREENS #15932 901 BITTERS RD
SAN ANTONIOTX7821601/01/2017  
CH063250WALGREEN CO.DBA: WALGREENS # 04552 4703 W. COMMERCE ST.
SAN ANTONIOTX7823710/01/2020  
CH063250WALGREEN CO.DBA:WALGREENS #10787 12352 FM 1957
SAN ANTONIOTX7825307/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS # 09697 10003 W LOOP 1604 N
SAN ANTONIOTX7825407/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS # 06537 14882 BLANCO ROAD
SAN ANTONIOTX7821607/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS # 05765 1223 S MAIN ST
BOERNETX7800607/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS # 04550 639 E. HOPKINS ST.
SAN MARCOSTX7866607/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS #11521 10858 WURZBACH RD.
SAN ANTONIOTX78230-243407/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS #11725 2070 W. OAKLAWN RD.
PLEASANTONTX7806407/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS #12716 12020 CULEBRA RD
SAN ANTONIOTX7825307/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS # 09810 1357 EAST COURT STREET
SEGUINTX78155-513007/01/2021  
CH063250WALGREEN CO.DBA: WALGREENS # 02944 7423 BROADWAY ST
SAN ANTONIOTX7820907/01/2021  
CH063250WALGREEN CO.DBA:WALGREENS #15621 25215 INTERSTATE10 W
SAN ANTONIOTX7825704/01/2022  
CH063250WALGREEN CO.DBA: WALGREENS #13940 26482 US HIGHWAY 281 N
SAN ANTONIOTX7825804/01/2022  
CH063250WALGREEN CO.DBA: WALGREENS # 06336 10718 BANDERA ROAD
SAN ANTONIOTX7825004/01/2022  
CH06325ACWALGREEN CO.DBA: WALGREENS # 02458 7802 WURZBACH ROAD
SAN ANTONIOTX7822910/01/2024  
CH06325HWALGREEN CO.DBA: WALGREENS # 05424 138 SW MILITARY DRIVE
SAN ANTONIOTX7822110/01/2024 04/01/2025
CH06325LWALGREEN CO.DBA: WALGREENS # 07371 7019 S ZARZAMORA ST
SAN ANTONIOTX78224-114110/01/2024  
CH06325ADWALGREEN CO.DBA: WALGREENS # 06335 14025 NACOGDOCHES RD
SAN ANTONIOTX78247-191810/01/2024  
CH063250Walgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200 		NorthlakeTX7626201/01/2022  
CH063250WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700810/01/2020 09/20/2021
CH063250WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2020  
CH063250WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2020  
CH063250WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2020  
CH063250WALMART PHARMACY 10-31068538 IH-35 SOUTH
SAN ANTONIOTX7821107/01/2019  
CH06325ZWALMART PHARMACY 10-31068538 IH-35 SOUTH
SAN ANTONIOTX7821110/01/2024  
CH063250WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/01/2023  
CH063250Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdate Gomez, Ernesto President / CEO 2103343703Gomez, Ernesto President / CEO CemrtoMed 210334370311/20/2017 7:06 PM
ContactsPrimary ContactUpdate Macaulay, Don VP / Chief Operating Officer 2103343705Macaulay, Don VP / Chief Operating Officer CentroMed 210334370511/13/2017 12:36 PM
ContactsAuthorizing OfficialInsert  Gomez, Ernesto President / CEO 21033437032/13/2017 6:54 AM
ContactsPrimary ContactUpdate Wei, Raymond VP Busn Dev/Ancillary Services 2103343738Macaulay, Don VP / Chief Operating Officer 21033437052/13/2017 6:54 AM
AddressesMain AddressInsert   1614 San Antonio Street New Braunfels, TX 78130-62731/13/2017 6:44 AM
AddressesBilling AddressInsert  El Centro del Barrio dba CentroMed 3750 Commercial Ave San Antonio, TX 782211/13/2017 6:44 AM
AddressesShipping AddressInsert  CentroMed Pharmacy 918 Wagner San Antonio, TX 782111/13/2017 6:44 AM
DatesLast Date That 340B Drugs PurchasedUpdate  12/31/2016 12:00:00 AM1/13/2017 6:44 AM
DatesParticipating Approval DateUpdate 11/19/2004 5:45:08 PM11/19/2004 12:00:00 AM1/13/2017 6:44 AM
DetailsStateUpdate ActiveTerminated1/13/2017 6:44 AM
TerminationsTermination DateUpdate  4/1/2017 12:00:00 AM1/13/2017 6:44 AM
TerminationsTermination Effective DateUpdate  12/31/2016 12:00:00 AM1/13/2017 6:44 AM
TerminationsTermination ReasonUpdate  Site closure1/13/2017 6:44 AM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM3/1/2016 12:00:00 AM3/1/2016 11:02 AM
ContactsPrimary ContactInsert  Wei, Raymond VP Busn Dev/Ancillary Services 21033437381/19/2016 4:53 PM
DetailsLast Recertification DateUpdate 3/13/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 12:56 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/13/2014 12:00:00 AM3/13/2014 2:38 PM
DetailsEntity NameUpdate EL CENTRO DEL BARRIO, INC. DBA CENTROMEDEl Centro Del Barrio3/13/2014 2:38 PM
DetailsEntity SubnameUpdate San Antonio Street ClinicCENTROMED SAN ANTONIO STREET CLINIC3/13/2014 2:38 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/15/2013 12:02 PM
DetailsEntity SubnameUpdate DWYER CLINICSan Antonio Street Clinic3/15/2013 12:02 PM
DetailsLast Recertification DateInsert   11/19/2004 5:45 PM
DetailsGrant NumberInsert  H80CS0075811/19/2004 5:45 PM
Details340B IDInsert  CH06325E11/19/2004 5:45 PM
DetailsIs Authorizing Official EHB DataInsert   11/19/2004 5:45 PM
DatesLast Date That 340B Drugs PurchasedInsert   11/19/2004 5:45 PM
DetailsMedicare Provider NumberInsert   11/19/2004 5:45 PM
DetailsEntity NameInsert  EL CENTRO DEL BARRIO, INC. DBA CENTROMED11/19/2004 5:45 PM
DetailsProgram CodeInsert  CH11/19/2004 5:45 PM
DetailsEntity SubnameInsert  DWYER CLINIC11/19/2004 5:45 PM
DatesParticipating Approval DateInsert  11/19/2004 5:45:08 PM11/19/2004 5:45 PM
DetailsStateInsert  Active11/19/2004 5:45 PM
DatesRegistration DateInsert  1/1/2005 12:00:00 AM11/19/2004 5:45 PM
DatesSigned By DateInsert   11/19/2004 5:45 PM
DatesStart DateInsert  1/1/2005 12:00:00 AM11/19/2004 5:45 PM
TerminationsTermination CommentsInsert   11/19/2004 5:45 PM
TerminationsTermination DateInsert   11/19/2004 5:45 PM
TerminationsTermination Effective DateInsert   11/19/2004 5:45 PM
TerminationsTermination ReasonInsert   11/19/2004 5:45 PM
DetailsComments PublicInsert  NEW SITE 01/01/200511/19/2004 5:45 PM