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LAKESIDE PHARMACY SOUTH
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
LAKESIDE PHARMACY SOUTH
Pharmacy Address
4151 JAIME ZAPATA MEMORIAL HWY. STE., 20
LAREDO, TX 78043
Pharmacy Comments
Contract Details
Approval Date
1/19/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Miguel Trevino Jr., CEO
(956) 523-3645
Contract Pharmacy Representative
Chuck Orgi, Owner
(956) 724-2090
Signed By Date
1/19/2016
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