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HEB PHARMACY #057
CH0627970 AMISTAD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AMISTAD COMMUNITY HEALTH CENTER
Subdivision Name
AMISTAD COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0627970
Entity Address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Grant Number
H80CS08778
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #057
Pharmacy Address
1145 WALDRON
CORPUS CHRISTI, TX 78418
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kenneth Waller, CEO
(361) 886-3090
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
4/11/2019
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