Contract Pharmacy Details

HEB Pharmacy #701
CH063250 El Centro Del Barrio

Covered Entity Details

Entity Name

El Centro Del Barrio

Subdivision Name

CentroMed Southside Medical Clinic

Type

HRSA-Funded Health Center

340B ID

CH063250

Entity Address

3750 Commercial Ave
San Antonio, TX 78221-3117

Grant Number

H80CS00758

Participating Start Date

12/1/1992

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

HEB Pharmacy #701

Pharmacy Address

6520 Fratt Road
San Antonio, TX 78218

Pharmacy Comments

Contract Details

Approval Date

7/3/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/13/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578

Signed By Date

7/3/2019