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CH04243V THE COASTAL FAMILY HEALTH CENTER INC (Terminated)
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Main Details
Name
THE COASTAL FAMILY HEALTH CENTER INC
Subdivision Name
Leakesville Dental Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-019156
340B ID
CH04243V
Grant Number
H80CS00188
Additional Details
Current Program Status
Terminated
Registration Date
1/31/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
1/29/2020
Termination Date
Termination Reason
4/1/2021
Other
Contacts
Authorizing Official
Coastal Family Health Center
ANGEL GREER, CEO
(228) 374-2494 Ext: 1133
Primary Contact
Coastal Family Health Center
Larry J. Knight, COO
(228) 374-2494 Ext: 1116
Addresses
Street Address
1614 Williams DR
Leakesville, MS 39451-9602
Billing Address
Coastal Family Health Center
PO Box 475
Biloxi, MS 39533
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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