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FRY'S PRESCRIPTION PHARMACY
CH06084C SU CLINICA FAMILIAR
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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
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/29/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ELENA MARIN, CEO
(956) 365-6010 Ext: 1330
Contract Pharmacy Representative
Fry's Pharmacy
Abigial Vasquez, Owner
(956) 399-2453
Signed By Date
4/15/2016
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