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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05964
3401 SAN PEDRO
SAN ANTONIO, TX 78212
Pharmacy Comments
Contract Details
Approval Date
12/6/2011
Contract Begin Date
11/22/2011
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
11/1/2011
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