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MARKET STREET PHARMACY #678
CH066570 LA ESPERANZA CLINIC, INC.
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Covered Entity Details
Entity Name
LA ESPERANZA CLINIC, INC.
Subdivision Name
LA ESPERANZA CLINIC
Type
HRSA-Funded Health Center
340B ID
CH066570
Entity Address
1610 S Chadbourne St
San Angelo, TX 76903-8510
Grant Number
H80CS00203
Participating Start Date
7/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MARKET STREET PHARMACY #678
Pharmacy Address
3121 SUNSET DR
SAN ANGELO, TX 76904
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dean Munn, CEO
(325) 947-5600
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/17/2022
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