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WAL-MART PHARMACY 10-1260
CH042430 THE COASTAL FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
THE COASTAL FAMILY HEALTH CENTER INC
Subdivision Name
COASTAL FAMILY HEALTH CENTER CORPORATE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH042430
Entity Address
10467 Corporate Drive
Gulfport, MS 39503
Grant Number
H80CS00188
Participating Start Date
7/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1260
Pharmacy Address
11228 HIGHWAY 63 SOUTH
LUCEDALE, MS 39452
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANGEL GREER, CEO
(228) 374-2494 Ext: 1133
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
10/13/2016
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