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WALGREEN CO.
CH06325L El Centro Del Barrio
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Covered Entity Details
Entity Name
El Centro Del Barrio
Subdivision Name
CENTROMED SOUTH PARK DENTAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06325L
Entity Address
910 Wagner Ave
San Antonio, TX 78211-3213
Grant Number
H80CS00758
Participating Start Date
1/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07371
7019 S ZARZAMORA ST
SAN ANTONIO, TX 78224-1141
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/8/2024
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