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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
710 OVILLA ROAD
WAXAHACHIE, TX 75167
Pharmacy Comments
08/15/2012 Distribution Center
Contract Details
Approval Date
3/5/2012
Contract Begin Date
3/5/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/8/2015
Business decision by covered entity and/or pharmacy
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
2/7/2012
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