Contract Pharmacy Details

FRY'S PRESCRIPTION PHARMACY
CH06084C SU CLINICA FAMILIAR

Covered Entity Details

Entity Name

SU CLINICA FAMILIAR

Subdivision Name

Southern Cameron County Clinic

Type

HRSA-Funded Health Center

340B ID

CH06084C

Entity Address

105 E. Alton Gloor Blvd.
BROWNSVILLE, TX 78526

Grant Number

H80CS00348

Participating Start Date

7/1/1993

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

FRY'S PRESCRIPTION PHARMACY

Pharmacy Address

311 N. SAM HOUSTON
SAN BENITO, TX 78586-4656

Pharmacy Comments

Contract Details

Approval Date

7/16/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/13/2016
Ownership change

Contacts

Covered Entity Signing Official

ELENA MARIN, CEO
(956) 365-6010 Ext: 1330

Contract Pharmacy Representative

Ed Walsh, Owner
(956) 399-2453

Signed By Date

7/16/2015