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CVS PHARMACY, INC.
CH06325AN EL CENTRO DEL BARRIO
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Covered Entity Details
Entity Name
EL CENTRO DEL BARRIO
Subdivision Name
CentroMed SA Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH06325AN
Entity Address
9150 Huebner Rd
240
San Antonio, TX 78240-1334
Grant Number
H80CS00758
Participating Start Date
10/1/2022
Last Recertification Date
1/29/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY #10597
8731 POTEET JOURDANTON FREEWAY
SAN ANTONIO, TX 78224
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ernesto Gomez, President / CEO
(210) 334-3703
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/8/2024
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