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HEB PHARMACY #384
CH06325AM 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
CH06325AM
Entity Address
580 Cibolo Valley Dr
STE 221
Cibolo, TX 78108-4094
Grant Number
H80CS00758
Participating Start Date
10/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #384
Pharmacy Address
6030 MONTGOMERY RD
SAN ANTONIO, TX 78239
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ernesto Gomez, President / CEO
(210) 334-3703
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
7/8/2024
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