340B Drug Pricing Program Database


CH04243AD Coastal Family Health Center, Inc. (Active) - information as of 5/1/2025 11:46:40 PM

Main Details
Coastal Family Health Center, Inc.
Lucedale Health Center
HRSA-Funded Health Center
BPS-H80-027510
CH04243AD
H80CS00188


Additional Details
Active
7/8/2019
10/1/2019
7/9/2019
2/14/2025

Contacts

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

Coastal Family Health Center
Racheal Butler, Director of Pharmacy Services
(228) 374-2494

Addresses

11231 Old 63 S
Lucedale, MS 39452-4941

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MS07221560,07835321,02834246,06958781,009340741134583305,1740417922,1861950982,1609453844,1437826989
Shipping Addresses

Coastal Family Health Center
9113 Hwy 49 Suite 200
Gulfport, MS 39503

Coastal Family Health Center
951 Main Street
Leakesville, MS 39451

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

Coastal Family Health Center
1029B Division Street
Biloxi, MS 39530
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH042430ActiveBPS-H80-038716THE COASTAL FAMILY HEALTH CENTER INCCOASTAL FAMILY HEALTH CENTER CORPORATE OFFICE10467 Corporate Drive GulfportMS
CH04243AActiveBPS-H80-000592THE COASTAL FAMILY HEALTH CENTER INCVANCLEAVE HEALTH CENTER10828 Highway 57 VancleaveMS
CH04243AAActiveBPS-H80-018069THE COASTAL FAMILY HEALTH CENTER INCSBHC- Magnolia4630 Magnolia Street Moss PointMS
CH04243ABActiveBPS-H80-021914Coastal Family Health Center, Inc.SBHC- Kreole6312 Martin Luther King Blvd Moss PointMS
CH04243ACActiveBPS-H80-021996Coastal Family Health Center, Inc.SBHC-Escatawpa4208 Jamestown Rd Moss PointMS
CH04243ADActiveBPS-H80-027510Coastal Family Health Center, Inc.Lucedale Health Center11231 Old 63 S LucedaleMS
CH04243AEActiveBPS-H80-031514Coastal Family Health Center, Inc.SBHC - East Central High5500 Hurley Wade Rd Moss PointMS
CH04243AFActiveBPS-H80-035227Coastal Family Health Center, Inc.SBHC - St. Martin High11300 Yellow Jacket Rd Ocean SpringsMS
CH04243AGActiveBPS-H80-031512Coastal Family Health Center, Inc.SBHC - Vancleave High12424 Highway 57 VancleaveMS
CH04243AHActiveBPS-H80-033618Coastal Family Health Center, Inc.SBHC - East Central Upper Elementary5404 Hurley Wade Rd Moss PointMS
CH04243AJActiveBPS-H80-033616Coastal Family Health Center, Inc.SBHC - Bay Waveland Middle600 Pine St Bay St LouisMS
CH04243AKActiveBPS-H80-033615Coastal Family Health Center, Inc.SBHC - North Bay Elementary602 Pine St Bay St LouisMS
CH04243ALActiveBPS-H80-033614Coastal Family Health Center, Inc.SBHC - Vancleave Upper Elementary13901 Highway 57 VancleaveMS
CH04243AMActiveBPS-H80-033613Coastal Family Health Center, Inc.SBHC - St. Martin North Elementary16308 Lemoyne Blvd BiloxiMS
CH04243ANActiveBPS-H80-033619Coastal Family Health Center, Inc.SBHC - Bay High750 Blue Meadow Rd Bay St LouisMS
CH04243APActiveBPS-H80-033617Coastal Family Health Center, Inc.SBHC - Waveland Elementary1101 Saint Joseph St WavelandMS
CH04243AQActiveBPS-H80-033506Coastal Family Health Center, Inc.CFHC Mobile Care10467 Corporate Drive GulfportMS
CH04243ARActiveBPS-H80-037413COASTAL FAMILY HEALTH CENTERSBHC - East Hancock Elementary4221 Kiln-Delisle Rd KilnMS
CH04243ASActiveBPS-H80-037420COASTAL FAMILY HEALTH CENTERSBHC - Hancock North Central Elementary6122 Cuevas Town Rd KilnMS
CH04243ATActiveBPS-H80-037416COASTAL FAMILY HEALTH CENTERSBHC - South Hancock Elementary6590 Lakeshore Rd Bay Saint LouisMS
CH04243AUActiveBPS-H80-038437COASTAL FAMILY HEALTH CENTERSBHC - Hancock Middle7070 Stennis Airport Rd KilnMS
CH04243AVActiveBPS-H80-033869COASTAL FAMILY HEALTH CENTERWiggins Health Center1407 Central Ave E WigginsMS
CH04243BActiveBPS-H80-001812THE COASTAL FAMILY HEALTH CENTER INCGULFPORT HEALTH CENTER15024 MARTIN L. KING JR BLVD GULFPORTMS
CH04243DActiveBPS-H80-000563THE COASTAL FAMILY HEALTH CENTER INCSAUCIER HEALTH CENTER23453 Central Dr SaucierMS
CH04243EActiveBPS-H80-004067THE COASTAL FAMILY HEALTH CENTER INCBAY ST. LOUIS HEALTH CENTER109 Hospital Dr Bay Saint LouisMS
CH04243FActiveBPS-H80-008621THE COASTAL FAMILY HEALTH CENTER INCD'Iberville Health Center3446 Popps Ferry Road DibervilleMS
CH04243GActiveBPS-H80-010283THE COASTAL FAMILY HEALTH CENTER INCPass Christian Health Center257 Davis Street Pass ChristianMS
CH04243HActiveBPS-H80-010611THE COASTAL FAMILY HEALTH CENTER INCMOSS POINT HEALTH CENTER4770 Amoco Drive Moss PointMS
CH04243JTerminatedBPS-H80-013782THE COASTAL FAMILY HEALTH CENTER INCCoastal Family Health Center Pharmacy1025 DIVISION ST STE A BILOXIMS
CH04243KActiveBPS-H80-014793THE COASTAL FAMILY HEALTH CENTER INCBiloxi Health Center715-A Division Street BiloxiMS
CH04243LTerminatedBPS-H80-008816THE COASTAL FAMILY HEALTH CENTER INCGULFPORT II HEALTH CENTER1408 44th Ave GulfportMS
CH04243MActiveBPS-H80-010081THE COASTAL FAMILY HEALTH CENTER INCBILOXI PEDIATRIC HEALTH CENTER735 Division Street BiloxiMS
CH04243PActiveBPS-H80-021145THE COASTAL FAMILY HEALTH CENTER INCSBHC-Moss Point High4913 Weems Street Moss PointMS
CH04243QTerminatedBPS-H80-002762THE COASTAL FAMILY HEALTH CENTER INCMedical/Dental Mobile Unit1046 Division Street BiloxiMS
CH04243RTerminatedBPS-H80-005487THE COASTAL FAMILY HEALTH CENTER INCED MAYO MIDDLE SCHOOL CLINIC6601 Orange Grove Rd Moss PointMS
CH04243SActiveBPS-H80-019159THE COASTAL FAMILY HEALTH CENTER INCSBHC-McLain300 Shows ST McLainMS
CH04243TActiveBPS-H80-019158THE COASTAL FAMILY HEALTH CENTER INCSBHC - Leakesville Elementary175 Annex Road LeakesvilleMS
CH04243UActiveBPS-H80-031905THE COASTAL FAMILY HEALTH CENTER INCLeakesville Health Center951 Main Street LeakesvilleMS
CH04243VTerminatedBPS-H80-019156THE COASTAL FAMILY HEALTH CENTER INCLeakesville Dental Clinic1614 Williams DR LeakesvilleMS
CH04243WActiveBPS-H80-019155THE COASTAL FAMILY HEALTH CENTER INCSBHC-Greene County High4336 High School Road LeakesvilleMS
CH04243XActiveBPS-H80-020826THE COASTAL FAMILY HEALTH CENTER INCState Line Health Center256 Main Street State LineMS
CH04243YActiveBPS-H80-019153THE COASTAL FAMILY HEALTH CENTER INCSBHC-Leakesville Jr High620 Main St LeakesvilleMS
CH04243ZActiveBPS-H80-020864THE COASTAL FAMILY HEALTH CENTER INCSBHC-Sand Hill39455 Highway 63 N RichtonMS
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH042430AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291107/01/2025  
CH042430AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700307/01/2025  
CH042430AVITA PHARMACY 1037AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC 2519 CANAL ST
NEW ORLEANSLA7011904/01/2014  
CH042430AVITA PHARMACY 1038AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM 3308 TULANE AVE STE 102
NEW ORLEANSLA70119-717004/01/2021 07/16/2024
CH042430AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080804/01/2014  
CH042430AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503407/01/2025  
CH042430BEAUMONT DRUGS LLCDBA BEAUMONT DRUGS 881 HIGHWAY 198
P.O. BOX 677 		BEAUMONTMS39423-207010/01/2024  
CH042430BURNHAM MCKINNEY PHARMACY #2PO BOX 722 7709 HIGHWAY 613
ESCATAWPAMS39552-072201/01/2014 10/15/2019
CH042430BURNHAM-MCKINNEY PHARMACY #15001 MAIN ST POST OFFICE BOX 8647
MOSS POINTMS39563-273801/01/2014 10/15/2019
CH042430BURNHAM-MCKINNEY PHARMACY #412500 HIGHWAY 57
VANCLEAVEMS3956501/01/2014 10/15/2019
CH042430BURNHAM-MCKINNEY PHARMACY #5608 HOWARD AVENUE
BILOXIMS39530-431001/01/2014 10/15/2019
CH04243MCOASTAL FAMILY HEALTH CENTER, INC1029B DIVISION ST
BILOXIMS3953007/01/2015  
CH04243LCOASTAL FAMILY HEALTH CENTER, INC1029B DIVISION ST
BILOXIMS3953007/01/2015 04/01/2016
CH04243KCOASTAL FAMILY HEALTH CENTER, INC1029B DIVISION ST
BILOXIMS3953007/01/2015  
CH04243JCOASTAL FAMILY HEALTH CENTER, INC1029B DIVISION ST
BILOXIMS3953007/01/2015 07/01/2021
CH042430COUNTY DISCOUNT DRUGCOUNTY DISCOUNT DRUG, INC. 820 HALL ST
WIGGINSMS39577-395710/01/2024  
CH042430DOBBINS FAMILY PHARMACY, LLC1017 HIGHWAY 57
LEAKESVILLEMS39451-580701/01/2020 06/30/2023
CH042430EDWARDS DISCOUNT DRUGS103 W FRONTAGE RD SUITE A
LUCEDALEMS39452-583610/01/2024  
CH042430FRED'S PHARMACY #2486951 MAIN STREET
LEAKESVILLEMS39451-650201/01/2017 10/15/2019
CH042430FRED'S PHARMACY #314612101 HWY 57
VANCLEAVEMS3956501/01/2017 12/11/2018
CH042430HODGES' PHARMACY INCFRANKLIN W HODGES JR OWNER 411 SAINT FRANCIS ST
PO BOX 699 		LEAKESVILLEMS39451-890907/01/2020 10/05/2023
CH042430K & B MISSISSIPPI CORPORATIONRITE AID #7223 11279 HIGHWAY 49
GULFPORTMS3950301/01/2016 01/26/2018
CH042430K & B MISSISSIPPI CORPORATIONRITE AID #7381 403 HIGHWAY 90
WAVELANDMS3957601/01/2016 01/26/2018
CH042430LOVE'S PHARMACY #2, INCLOVE'S PHARMACY, INC 45000 E ALOHA DR
SUITE B 		DIAMONDHEADMS3952510/01/2024  
CH042430M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312607/01/2025  
CH042430PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310107/01/2025  
CH042430PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/01/2017 10/01/2022
CH042430R & D PHARMACY23457 CENTRAL DR SUITE A
SAUCIERMS39574-752101/01/2015 05/31/2022
CH042430R & D PHARMACY23457 CENTRAL DR STE A
SAUCIERMS3957407/01/2022  
CH042430SARTIN'S DISCOUNT DRUGS INC4300 15TH ST SUITE 1
GULFPORTMS39501-252404/01/2015  
CH042430St Vincent de Paul Community Pharmacy, Inc715-B Division St
BiloxiMS3953001/01/2017  
CH042430T D PHARMACYT-D PHARMACY, INC. 12372 HIGHWAY 49
GULFPORTMS39503-274101/01/2014 10/15/2019
CH042430T D PHARMACYT-D PHARMACY, INC. 12372 HIGHWAY 49
GULFPORTMS39503-274101/01/2021  
CH042430WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2019  
CH042430WAL-MART PHARMACY 10-07851350 AZALEA DR
WAYNESBOROMS3936701/01/2017 10/15/2019
CH042430WAL-MART PHARMACY 10-09699350-A HIGHWAY 49 NORTH
GULFPORTMS3950304/01/2014  
CH042430WAL-MART PHARMACY 10-10664253 DENNY AVE
PASCAGOULAMS3958104/01/2014  
CH042430WAL-MART PHARMACY 10-10882681 C.T. SWITZER SR. DRIVE
BILOXIMS3953107/01/2018  
CH042430WAL-MART PHARMACY 10-1195460 HWY 90
WAVELANDMS3957604/01/2014  
CH042430WAL-MART PHARMACY 10-126011228 HIGHWAY 63 SOUTH
LUCEDALEMS3945201/01/2017  
CH042430WAL-MART PHARMACY 10-13463911 BIENVILLE BLVD
OCEAN SPRINGSMS3956404/01/2019  
CH042430WAL-MART PHARMACY 10-27153615 SANGANI BLVD.
D'IBERVILLEMS3954004/01/2015  
CH042430WAL-MART PHARMACY 10-35281053 FRONTAGE DRIVE EAST
WIGGINSMS3957704/01/2019  
CH042430WAL-MART PHARMACY 10-50791617 EAST BEACH BLVD.
PASS CHRISTIANMS3957107/01/2018  
CH042430WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2019  
CH042430WAL-MART PHARMACY 10-616610290 D'IBERVILLE RD
DIBERVILLEMS3954004/01/2019  
CH042430WALGREEN CODBA: WALGREENS #10360 2601 HIGHWAY 90
GAUTIERMS3955310/01/2013  
CH042430WALGREEN CODBA: WALGREENS #10909 12007 LAMEY BRIDGE ROAD
DIBERVILLEMS3954010/01/2013  
CH042430WALGREEN CO.DBA: WALGREENS # 04172 2405 PASS ROAD
BILOXIMS3953110/01/2013  
CH042430WALGREEN CO.DBA: WALGREENS #15484 1417 EAST PASS ROAD
GULFPORTMS3950710/01/2013  
CH042430WALGREEN CO.DBA: WALGREENS # 05195 15371 DEDEAUX RD.
GULFPORTMS3950310/01/2013  
CH042430WALGREEN CO.DBA: WALGREENS # 05653 3800 MARKET ST
PASCAGOULAMS3956710/01/2013  
CH042430WALGREEN CO.DBA: WALGREENS # 09545 120 W RAILROAD ST
LONG BEACHMS39560-463410/01/2013  
CH042430WALGREEN CO.DBA: WALGREENS #10321 348 HIGHWAY 90
WAVELANDMS39576-267210/01/2013  
CH042430WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21286 4500 OLD PASS RD
GULFPORTMS3950110/01/2015 06/08/2020
CH042430WALGREEN CO.RITE AID #07381 403 HIGHWAY 90
WAVELANDMS3957602/08/2018 06/24/2019
CH042430WALGREEN CO.WALGREENS #17031 11279 HIGHWAY 49
GULFPORTMS3950302/08/2018  
CH042430WALGREEN CO.WALGREENS #18039 3082 BIENVILLE BLVD
OCEAN SPRINGSMS3956407/01/2019  
CH042430WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21286 4500 OLD PASS RD
GULFPORTMS3950104/06/2022  
CH042430Walgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101 		MemphisTN3811807/01/2025  
CH042430WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528410/01/2013 07/22/2015
CH042430WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2015  
CH042430WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/01/2015 10/01/2021
CH042430WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2015  
CH042430WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2015  
CH042430WALMART PHARMACY 10-45861820-A POPPS FERRY ROAD
BILOXIMS3953207/01/2018 10/02/2024
CH042430WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CH042430WALMART PHARMACY 10-632311333 HIGHWAY 49
GULFPORTMS3950307/01/2018  
CH042430WALMART PHARMACY 10-68492050 PASS ROAD
BILOXIMS3953107/01/2018  
CH042430Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH042430WHITE'S PHARMACY INC301 FIFTH AVE W
WIGGINSMS39577-220410/01/2024  
CH042430WILSON'S PHARMACY INCSIMON P. WILSON III 101 PINE AVE E
SIMON P WILSON III 		WIGGINSMS39577-275210/01/2024  
CH042430WOOLMARKET PHARMACY INC13034 SHRINERS BLVD SUITE A
BILOXIMS3953201/01/2014 10/15/2019
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/1/2024 5:22:36 PM2/14/2025 6:25:15 PM2/14/2025 6:25 PM
DetailsLast Recertification DateUpdateRecertification2/8/2023 11:54:16 AM2/1/2024 5:22:36 PM2/1/2024 5:22 PM
AddressesShipping AddressDeleteRecertificationCoastal Family Health Center 1046 Division Street Suite A Biloxi, MS 39530 2/8/2023 11:54 AM
DetailsLast Recertification DateUpdateRecertification2/11/2022 11:23:12 AM2/8/2023 11:54:16 AM2/8/2023 11:54 AM
AddressesShipping AddressInsertGroup Change Request Coastal Family Health Center 1029B Division Street Biloxi, MS 395301/6/2023 6:26 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False10/28/2022 9:49 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0093407410/28/2022 9:49 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request MS10/28/2022 9:49 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 143782698910/28/2022 9:49 AM
Medicaid BillingNPI: StateInsertGroup Change Request MS10/28/2022 9:49 AM
ContactsPrimary ContactUpdatePC Change RequestKnight, Larry J. COO Coastal Family Health Center 2283742494-1116Butler, Racheal Director of Pharmacy Services Coastal Family Health Center 228374249410/27/2022 10:19 AM
AddressesShipping AddressInsertGroup Change Request Coastal Family Health Center 7312 Hwy 63 N Moss Point, MS 395635/31/2022 10:17 AM
DetailsLast Recertification DateUpdateRecertification2/5/2021 11:22:36 AM2/11/2022 11:23:12 AM2/11/2022 11:23 AM
AddressesShipping AddressInsertChange Request Coastal Family Health Center 951 Main Street Leakesville, MS 394517/13/2021 9:56 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/7/2021 12:07 PM
Medicaid BillingMedicaid: NumberInsertChange Request 069587817/7/2021 12:07 PM
Medicaid BillingMedicaid: StateInsertChange Request MS7/7/2021 12:07 PM
Medicaid BillingNPI: NumberInsertChange Request 16094538447/7/2021 12:07 PM
Medicaid BillingNPI: StateInsertChange Request MS7/7/2021 12:07 PM
AddressesShipping AddressInsertChange Request Coastal Family Health Center 9113 Hwy 49 Suite 200 Gulfport, MS 395034/15/2021 1:54 PM
AddressesShipping AddressInsertChange Request Coastal Family Health Center 1046 Division Street Suite A Biloxi, MS 395304/15/2021 1:54 PM
DetailsEntity SubnameUpdateChange RequestCoastal Family Health Center LucedaleLucedale Health Center4/15/2021 1:54 PM
Medicaid BillingNPI: StateUpdateRecertification MS2/5/2021 11:22 AM
Medicaid BillingNPI: StateUpdateRecertification MS2/5/2021 11:22 AM
Medicaid BillingNPI: StateUpdateRecertification MS2/5/2021 11:22 AM
DetailsLast Recertification DateUpdateRecertification1/29/2020 12:03:49 PM2/5/2021 11:22:36 AM2/5/2021 11:22 AM
DetailsLast Recertification DateUpdateRecertification 1/29/2020 12:03:49 PM1/29/2020 12:03 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/2/2020 5:03 PM
Medicaid BillingMedicaid: NumberInsertChange Request 028342461/2/2020 5:03 PM
Medicaid BillingMedicaid: StateInsertChange Request MS1/2/2020 5:03 PM
Medicaid BillingNPI: NumberInsertChange Request 18619509821/2/2020 5:03 PM
DetailsStateUpdate ApprovedActive10/1/2019 12:04 AM
ContactsSigned ByInsertNew Registration GREER, ANGEL CEO Coastal Family Health Center 2283742494-11337/9/2019 12:18 PM
Details340B IDUpdateNew Registration CH04243AD7/9/2019 12:18 PM
DatesParticipating Approval DateUpdateNew Registration 7/9/2019 12:18:16 PM7/9/2019 12:18 PM
DetailsStateUpdateNew RegistrationPendingApproved7/9/2019 12:18 PM
DatesSigned By DateUpdateNew Registration 7/8/2019 2:59:17 PM7/9/2019 12:18 PM
DatesStart DateUpdateNew Registration 10/1/2019 12:00:00 AM7/9/2019 12:18 PM
AddressesMain AddressInsertNew Registration  11231 Old 63 S Lucedale, MS 39452-49417/8/2019 1:16 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/8/2019 1:16 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 072215607/8/2019 1:16 PM
Medicaid BillingMedicaid: StateInsertNew Registration MS7/8/2019 1:16 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/8/2019 1:16 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 078353217/8/2019 1:16 PM
Medicaid BillingMedicaid: StateInsertNew Registration MS7/8/2019 1:16 PM
Medicaid BillingNPI: NumberInsertNew Registration 11345833057/8/2019 1:16 PM
Medicaid BillingNPI: NumberInsertNew Registration 17404179227/8/2019 1:16 PM
ContactsAuthorizing OfficialInsertNew Registration GREER, ANGEL CEO Coastal Family Health Center 2283742494-11337/8/2019 1:16 PM
ContactsPrimary ContactInsertNew Registration Knight, Larry J. COO Coastal Family Health Center 2283742494-11167/8/2019 1:16 PM
DetailsLast Recertification DateInsertNew Registration  7/8/2019 1:16 PM
DetailsGrant NumberInsertNew Registration H80CS001887/8/2019 1:16 PM
Details340B IDInsertNew Registration  7/8/2019 1:16 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/8/2019 1:16 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/8/2019 1:16 PM
DetailsMedicare Provider NumberInsertNew Registration  7/8/2019 1:16 PM
DetailsEntity NameInsertNew Registration Coastal Family Health Center, Inc.7/8/2019 1:16 PM
DetailsProgram CodeInsertNew Registration CH7/8/2019 1:16 PM
DetailsEntity SubnameInsertNew Registration Coastal Family Health Center Lucedale7/8/2019 1:16 PM
DatesParticipating Approval DateInsertNew Registration  7/8/2019 1:16 PM
DetailsStateInsertNew Registration Pending7/8/2019 1:16 PM
DatesRegistration DateInsertNew Registration 7/8/2019 1:16:03 PM7/8/2019 1:16 PM
DatesSigned By DateInsertNew Registration  7/8/2019 1:16 PM
DatesStart DateInsertNew Registration  7/8/2019 1:16 PM
TerminationsTermination CommentsInsertNew Registration  7/8/2019 1:16 PM
TerminationsTermination DateInsertNew Registration  7/8/2019 1:16 PM
TerminationsTermination Effective DateInsertNew Registration  7/8/2019 1:16 PM
TerminationsTermination ReasonInsertNew Registration  7/8/2019 1:16 PM