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OMNICARE OF FORT WORTH
CH061750 GATEWAY COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
GATEWAY COMMUNITY HEALTH CENTER INC
Subdivision Name
GATEWAY COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH061750
Entity Address
1515 Pappas St
Laredo, TX 78041-1705
Grant Number
H80CS00779
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
OMNICARE OF FORT WORTH
Pharmacy Address
14450 TRINITY BLVD, SUITE 200
FORT WORTH, TX 76155
Pharmacy Comments
Contract Details
Approval Date
10/13/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elmo S. Lopez Jr., CEO
(956) 625-3001
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2021
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