Contract Pharmacy Details

WALGREEN CO.
CH066580 Centro San Vicente

Covered Entity Details

Entity Name

Centro San Vicente

Subdivision Name

None

Type

HRSA-Funded Health Center

340B ID

CH066580

Entity Address

8061 Alameda Ave
El Paso, TX 79915-4705

Grant Number

H80CS00637

Participating Start Date

10/1/1995

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11518
14300 HORIZON BLVD.
HORIZON CITY, TX 79928

Pharmacy Comments

Contract Details

Approval Date

1/8/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jose Luna, CEO
(915) 859-7545 Ext: 1215

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/8/2015

340B Drug Pricing Program Database