Covered Entity Details

CH042430 THE COASTAL FAMILY HEALTH CENTER INC (Active) - information as of 5/2/2025 10:36:59 PM

Main Details

Name

THE COASTAL FAMILY HEALTH CENTER INC

Subdivision Name

COASTAL FAMILY HEALTH CENTER CORPORATE OFFICE

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038716

340B ID

CH042430

Grant Number

H80CS00188

Additional Details

Current Program Status

Active

Registration Date

7/1/1999

Participating Start Date

7/1/1999

Participating Approval Date

7/1/1999

Last Recertification Date

2/14/2025

Contacts

Authorizing Official

Coastal Family Health Center
ANGEL GREER, CEO
(228) 374-2494 Ext: 1133

Primary Contact

Coastal Family Health Center
Warren Patrick Hutto, Director of Pharmacy Services
(228) 374-2476 Ext: 1082

Addresses

Street Address

10467 Corporate Drive
Gulfport, MS 39503

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MS	06958781,00934074,200015861,07221560,07835321	1134583305,1740417922,1609453844,1437826989,1003646951

Shipping Addresses

Shipping Address 1

Coastal Family Health Center Pharmacy Gulfport
9113 Highway 49
Suite 200
Gulfport, MS 39503-4301

Shipping Address 2

Coastal Family Health Center
7312 Hwy 63 N
Moss Point, MS 39563

Shipping Address 3

Coastal Family Health Center
1029 B Division street
Biloxi, MS 39530

Shipping Address 4

Coastal Family Health Center
951 Main Street
Leakesville, MS 39451

Shipping Address 5

Coastal Family Health Pharmacy Wiggins
1407 Central Avenue East
Wiggins, MS 39577

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/07/2025	07/01/2025		04/07/2025
Contract Detail	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/07/2025	07/01/2025		04/07/2025
Contract Detail	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	01/07/2014	04/01/2014		08/14/2024
Contract Detail	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	01/07/2021	04/01/2021	07/16/2024	03/11/2025
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/07/2014	04/01/2014		08/14/2024
Contract Detail	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/07/2025	07/01/2025		04/07/2025
Contract Detail	BEAUMONT DRUGS LLC	DBA BEAUMONT DRUGS	881 HIGHWAY 198 P.O. BOX 677	BEAUMONT	MS	39423-2070	07/15/2024	10/01/2024		10/01/2024
Contract Detail	BURNHAM MCKINNEY PHARMACY #2	PO BOX 722	7709 HIGHWAY 613	ESCATAWPA	MS	39552-0722	10/15/2013	01/01/2014	10/15/2019	10/15/2019
Contract Detail	BURNHAM-MCKINNEY PHARMACY #1	5001 MAIN ST	POST OFFICE BOX 8647	MOSS POINT	MS	39563-2738	10/15/2013	01/01/2014	10/15/2019	10/15/2019
Contract Detail	BURNHAM-MCKINNEY PHARMACY #4	12500 HIGHWAY 57		VANCLEAVE	MS	39565	10/15/2013	01/01/2014	10/15/2019	10/15/2019
Contract Detail	BURNHAM-MCKINNEY PHARMACY #5	608 HOWARD AVENUE		BILOXI	MS	39530-4310	10/15/2013	01/01/2014	10/15/2019	10/15/2019
Contract Detail	COUNTY DISCOUNT DRUG	COUNTY DISCOUNT DRUG, INC.	820 HALL ST	WIGGINS	MS	39577-3957	07/05/2024	10/01/2024		10/01/2024
Contract Detail	DOBBINS FAMILY PHARMACY, LLC	1017 HIGHWAY 57		LEAKESVILLE	MS	39451-5807	10/14/2019	01/01/2020	06/30/2023	03/12/2025
Contract Detail	EDWARDS DISCOUNT DRUGS	103 W FRONTAGE RD	SUITE A	LUCEDALE	MS	39452-5836	07/15/2024	10/01/2024		10/01/2024
Contract Detail	FRED'S PHARMACY #2486	951 MAIN STREET		LEAKESVILLE	MS	39451-6502	10/11/2016	01/01/2017	10/15/2019	10/15/2019
Contract Detail	FRED'S PHARMACY #3146	12101 HWY 57		VANCLEAVE	MS	39565	10/11/2016	01/01/2017	12/11/2018	12/14/2018
Contract Detail	HODGES' PHARMACY INC	FRANKLIN W HODGES JR OWNER	411 SAINT FRANCIS ST PO BOX 699	LEAKESVILLE	MS	39451-8909	04/02/2020	07/01/2020	10/05/2023	03/12/2025
Contract Detail	K & B MISSISSIPPI CORPORATION	RITE AID #7223	11279 HIGHWAY 49	GULFPORT	MS	39503	10/06/2015	01/01/2016	01/26/2018	02/08/2018
Contract Detail	K & B MISSISSIPPI CORPORATION	RITE AID #7381	403 HIGHWAY 90	WAVELAND	MS	39576	10/06/2015	01/01/2016	01/26/2018	02/08/2018
Contract Detail	LOVE'S PHARMACY #2, INC	LOVE'S PHARMACY, INC	45000 E ALOHA DR SUITE B	DIAMONDHEAD	MS	39525	07/11/2024	10/01/2024		10/01/2024
Contract Detail	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/07/2025	07/01/2025		04/07/2025
Contract Detail	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/07/2025	07/01/2025		04/07/2025
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/11/2017	10/01/2017	10/01/2022	10/19/2022
Contract Detail	R & D PHARMACY	23457 CENTRAL DR	SUITE A	SAUCIER	MS	39574-7521	10/15/2014	01/01/2015	05/31/2022	06/15/2022
Contract Detail	R & D PHARMACY	23457 CENTRAL DR STE A		SAUCIER	MS	39574	06/30/2022	07/01/2022		08/14/2024
Contract Detail	SARTIN'S DISCOUNT DRUGS INC	4300 15TH ST	SUITE 1	GULFPORT	MS	39501-2524	01/08/2015	04/01/2015		08/14/2024
Contract Detail	St Vincent de Paul Community Pharmacy, Inc	715-B Division St		Biloxi	MS	39530	10/11/2016	01/01/2017		08/14/2024
Contract Detail	T D PHARMACY	T-D PHARMACY, INC.	12372 HIGHWAY 49	GULFPORT	MS	39503-2741	10/01/2013	01/01/2014	10/15/2019	10/15/2019
Contract Detail	T D PHARMACY	T-D PHARMACY, INC.	12372 HIGHWAY 49	GULFPORT	MS	39503-2741	10/15/2020	01/01/2021		08/14/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/08/2019	04/01/2019		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-0785	1350 AZALEA DR		WAYNESBORO	MS	39367	10/13/2016	01/01/2017	10/15/2019	10/15/2019
Contract Detail	WAL-MART PHARMACY 10-0969	9350-A HIGHWAY 49 NORTH		GULFPORT	MS	39503	01/07/2014	04/01/2014		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-1066	4253 DENNY AVE		PASCAGOULA	MS	39581	01/07/2014	04/01/2014		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-1088	2681 C.T. SWITZER SR. DRIVE		BILOXI	MS	39531	04/16/2018	07/01/2018		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-1195	460 HWY 90		WAVELAND	MS	39576	01/07/2014	04/01/2014		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-1260	11228 HIGHWAY 63 SOUTH		LUCEDALE	MS	39452	10/13/2016	01/01/2017		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-1346	3911 BIENVILLE BLVD		OCEAN SPRINGS	MS	39564	01/08/2019	04/01/2019		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-2715	3615 SANGANI BLVD.		D'IBERVILLE	MS	39540	01/08/2015	04/01/2015		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-3528	1053 FRONTAGE DRIVE EAST		WIGGINS	MS	39577	01/08/2019	04/01/2019		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-5079	1617 EAST BEACH BLVD.		PASS CHRISTIAN	MS	39571	04/16/2018	07/01/2018		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/08/2019	04/01/2019		08/14/2024
Contract Detail	WAL-MART PHARMACY 10-6166	10290 D'IBERVILLE RD		DIBERVILLE	MS	39540	01/08/2019	04/01/2019		08/14/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #10360	2601 HIGHWAY 90	GAUTIER	MS	39553	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #10909	12007 LAMEY BRIDGE ROAD	DIBERVILLE	MS	39540	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04172	2405 PASS ROAD	BILOXI	MS	39531	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15484	1417 EAST PASS ROAD	GULFPORT	MS	39507	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05195	15371 DEDEAUX RD.	GULFPORT	MS	39503	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05653	3800 MARKET ST	PASCAGOULA	MS	39567	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09545	120 W RAILROAD ST	LONG BEACH	MS	39560-4634	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10321	348 HIGHWAY 90	WAVELAND	MS	39576-2672	07/05/2013	10/01/2013		08/14/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21286	4500 OLD PASS RD	GULFPORT	MS	39501	07/15/2015	10/01/2015	06/08/2020	07/06/2020
Contract Detail	WALGREEN CO.	RITE AID #07381	403 HIGHWAY 90	WAVELAND	MS	39576	02/08/2018	02/08/2018	06/24/2019	06/24/2019
Contract Detail	WALGREEN CO.	WALGREENS #17031	11279 HIGHWAY 49	GULFPORT	MS	39503	02/08/2018	02/08/2018		08/14/2024
Contract Detail	WALGREEN CO.	WALGREENS #18039	3082 BIENVILLE BLVD	OCEAN SPRINGS	MS	39564	04/11/2019	07/01/2019		08/14/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21286	4500 OLD PASS RD	GULFPORT	MS	39501	04/06/2022	04/06/2022		08/14/2024
Contract Detail	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	04/02/2025	07/01/2025		04/02/2025
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/05/2013	10/01/2013	07/22/2015	07/24/2015
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/10/2015	07/01/2015		08/14/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/10/2015	07/01/2015	10/01/2021	03/07/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/10/2015	07/01/2015		08/14/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/10/2015	07/01/2015		08/14/2024
Contract Detail	WALMART PHARMACY 10-4586	1820-A POPPS FERRY ROAD		BILOXI	MS	39532	04/16/2018	07/01/2018	10/02/2024	10/03/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/12/2023	04/01/2023		08/14/2024
Contract Detail	WALMART PHARMACY 10-6323	11333 HIGHWAY 49		GULFPORT	MS	39503	04/16/2018	07/01/2018		08/14/2024
Contract Detail	WALMART PHARMACY 10-6849	2050 PASS ROAD		BILOXI	MS	39531	04/16/2018	07/01/2018		08/14/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/11/2023	01/01/2024		08/14/2024
Contract Detail	WHITE'S PHARMACY INC	301 FIFTH AVE W		WIGGINS	MS	39577-2204	07/15/2024	10/01/2024		10/01/2024
Contract Detail	WILSON'S PHARMACY INC	SIMON P. WILSON III	101 PINE AVE E SIMON P WILSON III	WIGGINS	MS	39577-2752	07/05/2024	10/01/2024		10/01/2024
Contract Detail	WOOLMARKET PHARMACY INC	13034 SHRINERS BLVD	SUITE A	BILOXI	MS	39532	10/01/2013	01/01/2014	10/15/2019	10/15/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH042430	Active	BPS-H80-038716	THE COASTAL FAMILY HEALTH CENTER INC	COASTAL FAMILY HEALTH CENTER CORPORATE OFFICE	10467 Corporate Drive	Gulfport	MS
CH04243A	Active	BPS-H80-000592	THE COASTAL FAMILY HEALTH CENTER INC	VANCLEAVE HEALTH CENTER	10828 Highway 57	Vancleave	MS
CH04243AA	Active	BPS-H80-018069	THE COASTAL FAMILY HEALTH CENTER INC	SBHC- Magnolia	4630 Magnolia Street	Moss Point	MS
CH04243AB	Active	BPS-H80-021914	Coastal Family Health Center, Inc.	SBHC- Kreole	6312 Martin Luther King Blvd	Moss Point	MS
CH04243AC	Active	BPS-H80-021996	Coastal Family Health Center, Inc.	SBHC-Escatawpa	4208 Jamestown Rd	Moss Point	MS
CH04243AD	Active	BPS-H80-027510	Coastal Family Health Center, Inc.	Lucedale Health Center	11231 Old 63 S	Lucedale	MS
CH04243AE	Active	BPS-H80-031514	Coastal Family Health Center, Inc.	SBHC - East Central High	5500 Hurley Wade Rd	Moss Point	MS
CH04243AF	Active	BPS-H80-035227	Coastal Family Health Center, Inc.	SBHC - St. Martin High	11300 Yellow Jacket Rd	Ocean Springs	MS
CH04243AG	Active	BPS-H80-031512	Coastal Family Health Center, Inc.	SBHC - Vancleave High	12424 Highway 57	Vancleave	MS
CH04243AH	Active	BPS-H80-033618	Coastal Family Health Center, Inc.	SBHC - East Central Upper Elementary	5404 Hurley Wade Rd	Moss Point	MS
CH04243AJ	Active	BPS-H80-033616	Coastal Family Health Center, Inc.	SBHC - Bay Waveland Middle	600 Pine St	Bay St Louis	MS
CH04243AK	Active	BPS-H80-033615	Coastal Family Health Center, Inc.	SBHC - North Bay Elementary	602 Pine St	Bay St Louis	MS
CH04243AL	Active	BPS-H80-033614	Coastal Family Health Center, Inc.	SBHC - Vancleave Upper Elementary	13901 Highway 57	Vancleave	MS
CH04243AM	Active	BPS-H80-033613	Coastal Family Health Center, Inc.	SBHC - St. Martin North Elementary	16308 Lemoyne Blvd	Biloxi	MS
CH04243AN	Active	BPS-H80-033619	Coastal Family Health Center, Inc.	SBHC - Bay High	750 Blue Meadow Rd	Bay St Louis	MS
CH04243AP	Active	BPS-H80-033617	Coastal Family Health Center, Inc.	SBHC - Waveland Elementary	1101 Saint Joseph St	Waveland	MS
CH04243AQ	Active	BPS-H80-033506	Coastal Family Health Center, Inc.	CFHC Mobile Care	10467 Corporate Drive	Gulfport	MS
CH04243AR	Active	BPS-H80-037413	COASTAL FAMILY HEALTH CENTER	SBHC - East Hancock Elementary	4221 Kiln-Delisle Rd	Kiln	MS
CH04243AS	Active	BPS-H80-037420	COASTAL FAMILY HEALTH CENTER	SBHC - Hancock North Central Elementary	6122 Cuevas Town Rd	Kiln	MS
CH04243AT	Active	BPS-H80-037416	COASTAL FAMILY HEALTH CENTER	SBHC - South Hancock Elementary	6590 Lakeshore Rd	Bay Saint Louis	MS
CH04243AU	Active	BPS-H80-038437	COASTAL FAMILY HEALTH CENTER	SBHC - Hancock Middle	7070 Stennis Airport Rd	Kiln	MS
CH04243AV	Active	BPS-H80-033869	COASTAL FAMILY HEALTH CENTER	Wiggins Health Center	1407 Central Ave E	Wiggins	MS
CH04243B	Active	BPS-H80-001812	THE COASTAL FAMILY HEALTH CENTER INC	GULFPORT HEALTH CENTER	15024 MARTIN L. KING JR BLVD	GULFPORT	MS
CH04243D	Active	BPS-H80-000563	THE COASTAL FAMILY HEALTH CENTER INC	SAUCIER HEALTH CENTER	23453 Central Dr	Saucier	MS
CH04243E	Active	BPS-H80-004067	THE COASTAL FAMILY HEALTH CENTER INC	BAY ST. LOUIS HEALTH CENTER	109 Hospital Dr	Bay Saint Louis	MS
CH04243F	Active	BPS-H80-008621	THE COASTAL FAMILY HEALTH CENTER INC	D'Iberville Health Center	3446 Popps Ferry Road	Diberville	MS
CH04243G	Active	BPS-H80-010283	THE COASTAL FAMILY HEALTH CENTER INC	Pass Christian Health Center	257 Davis Street	Pass Christian	MS
CH04243H	Active	BPS-H80-010611	THE COASTAL FAMILY HEALTH CENTER INC	MOSS POINT HEALTH CENTER	4770 Amoco Drive	Moss Point	MS
CH04243J	Terminated	BPS-H80-013782	THE COASTAL FAMILY HEALTH CENTER INC	Coastal Family Health Center Pharmacy	1025 DIVISION ST STE A	BILOXI	MS
CH04243K	Active	BPS-H80-014793	THE COASTAL FAMILY HEALTH CENTER INC	Biloxi Health Center	715-A Division Street	Biloxi	MS
CH04243L	Terminated	BPS-H80-008816	THE COASTAL FAMILY HEALTH CENTER INC	GULFPORT II HEALTH CENTER	1408 44th Ave	Gulfport	MS
CH04243M	Active	BPS-H80-010081	THE COASTAL FAMILY HEALTH CENTER INC	BILOXI PEDIATRIC HEALTH CENTER	735 Division Street	Biloxi	MS
CH04243P	Active	BPS-H80-021145	THE COASTAL FAMILY HEALTH CENTER INC	SBHC-Moss Point High	4913 Weems Street	Moss Point	MS
CH04243Q	Terminated	BPS-H80-002762	THE COASTAL FAMILY HEALTH CENTER INC	Medical/Dental Mobile Unit	1046 Division Street	Biloxi	MS
CH04243R	Terminated	BPS-H80-005487	THE COASTAL FAMILY HEALTH CENTER INC	ED MAYO MIDDLE SCHOOL CLINIC	6601 Orange Grove Rd	Moss Point	MS
CH04243S	Active	BPS-H80-019159	THE COASTAL FAMILY HEALTH CENTER INC	SBHC-McLain	300 Shows ST	McLain	MS
CH04243T	Active	BPS-H80-019158	THE COASTAL FAMILY HEALTH CENTER INC	SBHC - Leakesville Elementary	175 Annex Road	Leakesville	MS
CH04243U	Active	BPS-H80-031905	THE COASTAL FAMILY HEALTH CENTER INC	Leakesville Health Center	951 Main Street	Leakesville	MS
CH04243V	Terminated	BPS-H80-019156	THE COASTAL FAMILY HEALTH CENTER INC	Leakesville Dental Clinic	1614 Williams DR	Leakesville	MS
CH04243W	Active	BPS-H80-019155	THE COASTAL FAMILY HEALTH CENTER INC	SBHC-Greene County High	4336 High School Road	Leakesville	MS
CH04243X	Active	BPS-H80-020826	THE COASTAL FAMILY HEALTH CENTER INC	State Line Health Center	256 Main Street	State Line	MS
CH04243Y	Active	BPS-H80-019153	THE COASTAL FAMILY HEALTH CENTER INC	SBHC-Leakesville Jr High	620 Main St	Leakesville	MS
CH04243Z	Active	BPS-H80-020864	THE COASTAL FAMILY HEALTH CENTER INC	SBHC-Sand Hill	39455 Highway 63 N	Richton	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH042430	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	07/01/2025
CH042430	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	07/01/2025
CH042430	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	04/01/2014
CH042430	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	04/01/2021	07/16/2024
CH042430	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	04/01/2014
CH042430	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	07/01/2025
CH042430	BEAUMONT DRUGS LLC	DBA BEAUMONT DRUGS	881 HIGHWAY 198 P.O. BOX 677	BEAUMONT	MS	39423-2070	10/01/2024
CH042430	BURNHAM MCKINNEY PHARMACY #2	PO BOX 722	7709 HIGHWAY 613	ESCATAWPA	MS	39552-0722	01/01/2014	10/15/2019
CH042430	BURNHAM-MCKINNEY PHARMACY #1	5001 MAIN ST	POST OFFICE BOX 8647	MOSS POINT	MS	39563-2738	01/01/2014	10/15/2019
CH042430	BURNHAM-MCKINNEY PHARMACY #4	12500 HIGHWAY 57		VANCLEAVE	MS	39565	01/01/2014	10/15/2019
CH042430	BURNHAM-MCKINNEY PHARMACY #5	608 HOWARD AVENUE		BILOXI	MS	39530-4310	01/01/2014	10/15/2019
CH04243M	COASTAL FAMILY HEALTH CENTER, INC	1029B DIVISION ST		BILOXI	MS	39530	07/01/2015
CH04243L	COASTAL FAMILY HEALTH CENTER, INC	1029B DIVISION ST		BILOXI	MS	39530	07/01/2015	04/01/2016
CH04243K	COASTAL FAMILY HEALTH CENTER, INC	1029B DIVISION ST		BILOXI	MS	39530	07/01/2015
CH04243J	COASTAL FAMILY HEALTH CENTER, INC	1029B DIVISION ST		BILOXI	MS	39530	07/01/2015	07/01/2021
CH042430	COUNTY DISCOUNT DRUG	COUNTY DISCOUNT DRUG, INC.	820 HALL ST	WIGGINS	MS	39577-3957	10/01/2024
CH042430	DOBBINS FAMILY PHARMACY, LLC	1017 HIGHWAY 57		LEAKESVILLE	MS	39451-5807	01/01/2020	06/30/2023
CH042430	EDWARDS DISCOUNT DRUGS	103 W FRONTAGE RD	SUITE A	LUCEDALE	MS	39452-5836	10/01/2024
CH042430	FRED'S PHARMACY #2486	951 MAIN STREET		LEAKESVILLE	MS	39451-6502	01/01/2017	10/15/2019
CH042430	FRED'S PHARMACY #3146	12101 HWY 57		VANCLEAVE	MS	39565	01/01/2017	12/11/2018
CH042430	HODGES' PHARMACY INC	FRANKLIN W HODGES JR OWNER	411 SAINT FRANCIS ST PO BOX 699	LEAKESVILLE	MS	39451-8909	07/01/2020	10/05/2023
CH042430	K & B MISSISSIPPI CORPORATION	RITE AID #7223	11279 HIGHWAY 49	GULFPORT	MS	39503	01/01/2016	01/26/2018
CH042430	K & B MISSISSIPPI CORPORATION	RITE AID #7381	403 HIGHWAY 90	WAVELAND	MS	39576	01/01/2016	01/26/2018
CH042430	LOVE'S PHARMACY #2, INC	LOVE'S PHARMACY, INC	45000 E ALOHA DR SUITE B	DIAMONDHEAD	MS	39525	10/01/2024
CH042430	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	07/01/2025
CH042430	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2025
CH042430	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/01/2017	10/01/2022
CH042430	R & D PHARMACY	23457 CENTRAL DR	SUITE A	SAUCIER	MS	39574-7521	01/01/2015	05/31/2022
CH042430	R & D PHARMACY	23457 CENTRAL DR STE A		SAUCIER	MS	39574	07/01/2022
CH042430	SARTIN'S DISCOUNT DRUGS INC	4300 15TH ST	SUITE 1	GULFPORT	MS	39501-2524	04/01/2015
CH042430	St Vincent de Paul Community Pharmacy, Inc	715-B Division St		Biloxi	MS	39530	01/01/2017
CH042430	T D PHARMACY	T-D PHARMACY, INC.	12372 HIGHWAY 49	GULFPORT	MS	39503-2741	01/01/2014	10/15/2019
CH042430	T D PHARMACY	T-D PHARMACY, INC.	12372 HIGHWAY 49	GULFPORT	MS	39503-2741	01/01/2021
CH042430	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019
CH042430	WAL-MART PHARMACY 10-0785	1350 AZALEA DR		WAYNESBORO	MS	39367	01/01/2017	10/15/2019
CH042430	WAL-MART PHARMACY 10-0969	9350-A HIGHWAY 49 NORTH		GULFPORT	MS	39503	04/01/2014
CH042430	WAL-MART PHARMACY 10-1066	4253 DENNY AVE		PASCAGOULA	MS	39581	04/01/2014
CH042430	WAL-MART PHARMACY 10-1088	2681 C.T. SWITZER SR. DRIVE		BILOXI	MS	39531	07/01/2018
CH042430	WAL-MART PHARMACY 10-1195	460 HWY 90		WAVELAND	MS	39576	04/01/2014
CH042430	WAL-MART PHARMACY 10-1260	11228 HIGHWAY 63 SOUTH		LUCEDALE	MS	39452	01/01/2017
CH042430	WAL-MART PHARMACY 10-1346	3911 BIENVILLE BLVD		OCEAN SPRINGS	MS	39564	04/01/2019
CH042430	WAL-MART PHARMACY 10-2715	3615 SANGANI BLVD.		D'IBERVILLE	MS	39540	04/01/2015
CH042430	WAL-MART PHARMACY 10-3528	1053 FRONTAGE DRIVE EAST		WIGGINS	MS	39577	04/01/2019
CH042430	WAL-MART PHARMACY 10-5079	1617 EAST BEACH BLVD.		PASS CHRISTIAN	MS	39571	07/01/2018
CH042430	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019
CH042430	WAL-MART PHARMACY 10-6166	10290 D'IBERVILLE RD		DIBERVILLE	MS	39540	04/01/2019
CH042430	WALGREEN CO	DBA: WALGREENS #10360	2601 HIGHWAY 90	GAUTIER	MS	39553	10/01/2013
CH042430	WALGREEN CO	DBA: WALGREENS #10909	12007 LAMEY BRIDGE ROAD	DIBERVILLE	MS	39540	10/01/2013
CH042430	WALGREEN CO.	DBA: WALGREENS # 04172	2405 PASS ROAD	BILOXI	MS	39531	10/01/2013
CH042430	WALGREEN CO.	DBA: WALGREENS #15484	1417 EAST PASS ROAD	GULFPORT	MS	39507	10/01/2013
CH042430	WALGREEN CO.	DBA: WALGREENS # 05195	15371 DEDEAUX RD.	GULFPORT	MS	39503	10/01/2013
CH042430	WALGREEN CO.	DBA: WALGREENS # 05653	3800 MARKET ST	PASCAGOULA	MS	39567	10/01/2013
CH042430	WALGREEN CO.	DBA: WALGREENS # 09545	120 W RAILROAD ST	LONG BEACH	MS	39560-4634	10/01/2013
CH042430	WALGREEN CO.	DBA: WALGREENS #10321	348 HIGHWAY 90	WAVELAND	MS	39576-2672	10/01/2013
CH042430	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21286	4500 OLD PASS RD	GULFPORT	MS	39501	10/01/2015	06/08/2020
CH042430	WALGREEN CO.	RITE AID #07381	403 HIGHWAY 90	WAVELAND	MS	39576	02/08/2018	06/24/2019
CH042430	WALGREEN CO.	WALGREENS #17031	11279 HIGHWAY 49	GULFPORT	MS	39503	02/08/2018
CH042430	WALGREEN CO.	WALGREENS #18039	3082 BIENVILLE BLVD	OCEAN SPRINGS	MS	39564	07/01/2019
CH042430	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21286	4500 OLD PASS RD	GULFPORT	MS	39501	04/06/2022
CH042430	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2025
CH042430	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/22/2015
CH042430	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2015
CH042430	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2015	10/01/2021
CH042430	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2015
CH042430	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2015
CH042430	WALMART PHARMACY 10-4586	1820-A POPPS FERRY ROAD		BILOXI	MS	39532	07/01/2018	10/02/2024
CH042430	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH042430	WALMART PHARMACY 10-6323	11333 HIGHWAY 49		GULFPORT	MS	39503	07/01/2018
CH042430	WALMART PHARMACY 10-6849	2050 PASS ROAD		BILOXI	MS	39531	07/01/2018
CH042430	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH042430	WHITE'S PHARMACY INC	301 FIFTH AVE W		WIGGINS	MS	39577-2204	10/01/2024
CH042430	WILSON'S PHARMACY INC	SIMON P. WILSON III	101 PINE AVE E SIMON P WILSON III	WIGGINS	MS	39577-2752	10/01/2024
CH042430	WOOLMARKET PHARMACY INC	13034 SHRINERS BLVD	SUITE A	BILOXI	MS	39532	01/01/2014	10/15/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 5:05:28 PM	2/14/2025 6:26:51 PM	2/14/2025 6:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/14/2025 9:09 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200015861	1/14/2025 9:09 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	1/14/2025 9:09 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1003646951	1/14/2025 9:09 AM
Medicaid Billing	NPI: State	Insert	Change Request		MS	1/14/2025 9:09 AM
Addresses	Shipping Address	Insert	Change Request		Coastal Family Health Pharmacy Wiggins 1407 Central Avenue East Wiggins, MS 39577	10/24/2024 6:45 AM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	6/30/2023 12:00:00 AM		8/14/2024 7:03 AM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	8/14/2024 7:03 AM
Terminations	Termination Date	Update	OPA Cancel Termination Request	10/1/2024 12:00:00 AM		8/14/2024 7:03 AM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	6/30/2023 12:00:00 AM		8/14/2024 7:03 AM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Terminated - Reason unknown		8/14/2024 7:03 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/30/2023 12:00:00 AM	8/12/2024 12:57 PM
Details	State	Update	Termination Request	Active	To Be Terminated	8/12/2024 12:57 PM
Terminations	Termination Date	Update	Termination Request		10/1/2024 12:00:00 AM	8/12/2024 12:57 PM
Terminations	Termination Effective Date	Update	Termination Request		6/30/2023 12:00:00 AM	8/12/2024 12:57 PM
Terminations	Termination Reason	Update	Termination Request		Terminated - Reason unknown	8/12/2024 12:57 PM
Addresses	Main Address	Update	Change Request	1046 Division St Biloxi, MS 39530-2935	10467 Corporate Drive Gulfport, MS 39503	6/25/2024 11:50 AM
Details	Entity Subname	Update	Change Request	COASTAL FAMILY HEALTH CENTER ADMINISTRATION	COASTAL FAMILY HEALTH CENTER CORPORATE OFFICE	6/25/2024 11:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/1/2024 5:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		06958781	2/1/2024 5:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	2/1/2024 5:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/1/2024 5:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		00934074	2/1/2024 5:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	2/1/2024 5:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1609453844	2/1/2024 5:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	2/1/2024 5:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437826989	2/1/2024 5:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	2/1/2024 5:05 PM
Details	Last Recertification Date	Update	Recertification	2/7/2023 2:50:08 PM	2/1/2024 5:05:28 PM	2/1/2024 5:05 PM
Contacts	Primary Contact	Update	PC Change Request	Butler, Racheal Director of Pharmacy Services Coastal Family Health Center 2283742494	Hutto, Warren Patrick Director of Pharmacy Services Coastal Family Health Center 2283742476-1082	11/22/2023 2:33 PM
Addresses	Shipping Address	Insert	Recertification		Coastal Family Health Center 1029 B Division street Biloxi, MS 39530	2/7/2023 2:50 PM
Addresses	Shipping Address	Insert	Recertification		Coastal Family Health Center 951 Main Street Leakesville, MS 39451	2/7/2023 2:50 PM
Addresses	Shipping Address	Delete	Recertification	Coastal Family Health Center 1025 A Division street Biloxi, MS 39530		2/7/2023 2:50 PM
Details	Last Recertification Date	Update	Recertification	2/11/2022 11:21:00 AM	2/7/2023 2:50:08 PM	2/7/2023 2:50 PM
Contacts	Primary Contact	Update	PC Change Request	Knight, Larry J. COO Coastal Family Health Center 2283742494-1116	Butler, Racheal Director of Pharmacy Services Coastal Family Health Center 2283742494	10/27/2022 10:19 AM
Addresses	Shipping Address	Insert	Group Change Request		Coastal Family Health Center 7312 Hwy 63 N Moss Point, MS 39563	5/31/2022 10:17 AM
Details	Last Recertification Date	Update	Recertification	2/5/2021 11:24:47 AM	2/11/2022 11:21:00 AM	2/11/2022 11:21 AM
Medicaid Billing	NPI: State	Update	Recertification		MS	2/5/2021 11:24 AM
Medicaid Billing	NPI: State	Update	Recertification		MS	2/5/2021 11:24 AM
Details	Last Recertification Date	Update	Recertification	1/29/2020 12:21:52 PM	2/5/2021 11:24:47 AM	2/5/2021 11:24 AM
Details	Last Recertification Date	Update	Recertification	2/1/2019 3:58:34 PM	1/29/2020 12:21:52 PM	1/29/2020 12:21 PM
Details	Last Recertification Date	Update	Recertification	2/8/2018 1:21:22 PM	2/1/2019 3:58:34 PM	2/1/2019 3:58 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/8/2018 1:21:22 PM	2/8/2018 1:21 PM
Contacts	Authorizing Official	Update		GREER, ANGEL CEO 2283742494-1133	GREER, ANGEL CEO Coastal Family Health Center 2283742494-1133	9/28/2017 10:22 AM
Contacts	Primary Contact	Update		Knight, Larry J. COO 2283742494-1116	Knight, Larry J. COO Coastal Family Health Center 2283742494-1116	9/27/2017 3:03 PM
Contacts	Authorizing Official	Update		Greer, Angel Executive Director 2283742424	GREER, ANGEL CEO 2283742494-1133	7/11/2017 4:16 PM
Contacts	Primary Contact	Update		Gentry, Lee Clinicadministrator 2283742494-1112	Knight, Larry J. COO 2283742494-1116	6/9/2017 11:29 AM
Addresses	Main Address	Insert			1046 Division St Biloxi, MS 39530-2935	6/9/2017 9:38 AM
Addresses	Shipping Address	Insert			Coastal Family Health Center 1025 A Division street Biloxi, MS 39530	6/9/2017 9:38 AM
Addresses	Shipping Address	Insert			Coastal Family Health Center Pharmacy Gulfport 9113 Highway 49 Suite 200 Gulfport, MS 39503-4301	6/9/2017 9:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/9/2017 9:37 AM
Medicaid Billing	Medicaid: Number	Insert			07221560	6/9/2017 9:37 AM
Medicaid Billing	Medicaid: State	Insert			MS	6/9/2017 9:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/9/2017 9:37 AM
Medicaid Billing	Medicaid: Number	Insert			07835321	6/9/2017 9:37 AM
Medicaid Billing	Medicaid: State	Insert			MS	6/9/2017 9:37 AM
Medicaid Billing	NPI: Number	Insert			1134583305	6/9/2017 9:37 AM
Medicaid Billing	NPI: Number	Insert			1740417922	6/9/2017 9:37 AM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/26/2017 9:48 AM
Details	Last Recertification Date	Update		1/28/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 1:39 PM
Contacts	Authorizing Official	Insert			Greer, Angel Executive Director 2283742424	10/14/2015 1:28 PM
Details	Last Recertification Date	Update		3/16/2014 12:00:00 AM	1/28/2015 12:00:00 AM	1/28/2015 12:18 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/16/2014 12:00:00 AM	3/16/2014 3:43 PM
Details	Entity Name	Update		COASTAL FAMILY HEALTH CENTER	THE COASTAL FAMILY HEALTH CENTER INC	3/16/2014 3:43 PM
Details	Entity Subname	Update			COASTAL FAMILY HEALTH CENTER ADMINISTRATION	3/16/2014 3:43 PM
Contacts	Primary Contact	Insert			Gentry, Lee Clinicadministrator 2283742494-1112	3/15/2013 1:06 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 1:03 PM
Details	Last Recertification Date	Insert				12/21/2005 2:27 PM
Details	Grant Number	Insert			H80CS00188	12/21/2005 2:27 PM
Details	340B ID	Insert			CH042430	12/21/2005 2:27 PM
Details	Is Authorizing Official EHB Data	Insert				12/21/2005 2:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/21/2005 2:27 PM
Details	Medicare Provider Number	Insert				12/21/2005 2:27 PM
Details	Entity Name	Insert			COASTAL FAMILY HEALTH CENTER	12/21/2005 2:27 PM
Details	Program Code	Insert			CH	12/21/2005 2:27 PM
Details	Entity Subname	Insert				12/21/2005 2:27 PM
Dates	Participating Approval Date	Insert			7/1/1999 12:00:00 AM	12/21/2005 2:27 PM
Details	State	Insert			Active	12/21/2005 2:27 PM
Dates	Registration Date	Insert			7/1/1999 12:00:00 AM	12/21/2005 2:27 PM
Dates	Signed By Date	Insert				12/21/2005 2:27 PM
Dates	Start Date	Insert			7/1/1999 12:00:00 AM	12/21/2005 2:27 PM
Terminations	Termination Comments	Insert				12/21/2005 2:27 PM
Terminations	Termination Date	Insert				12/21/2005 2:27 PM
Terminations	Termination Effective Date	Insert				12/21/2005 2:27 PM
Terminations	Termination Reason	Insert				12/21/2005 2:27 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History