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CVS PHARMACY, INC.
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
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 10311
2502 MARSHALL RD.
SAN ANTONIO, TX 78259
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Ernesto Gomez, President / CEO
(210) 334-3703
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2021
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