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CYSTIC FIBROSIS SERVICES, LLC
CH063250 El Centro Del Barrio
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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
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ernesto Gomez, President / CEO
(210) 334-3703
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2020
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