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CITY DRUG STORE
CHC08235-00 Preventative Care Health Services, INC.
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Covered Entity Details
Entity Name
Preventative Care Health Services, INC.
Subdivision Name
Preventative Care Health Services, INC.
Type
HRSA-Funded Health Center
340B ID
CHC08235-00
Entity Address
406 S. SUMMER STREET
MARFA, TX 79843
Grant Number
H80CS08235
Participating Start Date
10/1/2013
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
CITY DRUG STORE
Pharmacy Address
202 E AVE E
ALPINE, TX 79830
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Coy Boroff, CFO
(432) 729-1812
Contract Pharmacy Representative
Quinton Sledge, Manager
(432) 837-2252
Signed By Date
10/15/2014
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