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SOUTHSIDE INFUSION
CH062360 BARRIO COMPREHENSIVE FAMILY HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
BARRIO COMPREHENSIVE FAMILY HEALTH CARE CENTER, INC.
Subdivision Name
CommuniCare Health Centers - West
Type
HRSA-Funded Health Center
340B ID
CH062360
Entity Address
1102 Barclay St
San Antonio, TX 78207
Grant Number
H80CS00672
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SOUTHSIDE INFUSION
Pharmacy Address
7700 MAIN ST STE 210
HOUSTON, TX 77030-4457
Pharmacy Comments
Contract Details
Approval Date
4/2/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Nguyen, President & CEO
(210) 233-7070 Ext: 7886
Contract Pharmacy Representative
Southside Pharmacy
Roshan Koppuzhayil, Director of Pharmacy Operations
(832) 495-5597
Signed By Date
4/2/2020
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