Contract Pharmacy Details

MYERS DRUG INC
CH066570 LA ESPERANZA CLINIC, INC.

Covered Entity Details

Entity Name

LA ESPERANZA CLINIC, INC.

Subdivision Name

LA ESPERANZA CLINIC

Type

HRSA-Funded Health Center

340B ID

CH066570

Entity Address

1610 S Chadbourne St
San Angelo, TX 76903-8510

Grant Number

H80CS00203

Participating Start Date

7/1/1996

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

MYERS DRUG INC

Pharmacy Address

29 S CHADBOURNE
SAN ANGELO, TX 76903

Pharmacy Comments

Contract Details

Approval Date

7/12/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dean Munn, CEO
(325) 947-5600

Contract Pharmacy Representative

Doug Chadwick, PIC
(325) 655-3146

Signed By Date

7/12/2016