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St Vincent de Paul Community Pharmacy, Inc
HV395331 COASTAL FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
COASTAL FAMILY HEALTH CENTER
Subdivision Name
COASTAL FAMILY HEALTH CENTER - Ryan White
Type
Ryan White Part C
340B ID
HV395331
Entity Address
10467 Corporate Drive
Gulfport, MS 39503
Grant Number
H76HA00527
Participating Start Date
7/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
St Vincent de Paul Community Pharmacy, Inc
Pharmacy Address
715-B Division St
Biloxi, MS 39530
Pharmacy Comments
Contract Details
Approval Date
2/15/2012
Contract Begin Date
2/15/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angel Greer, Executive Director
(228) 374-2424
Contract Pharmacy Representative
Samuel J. Burke, Executive Director
(228) 374-9097
Signed By Date
2/6/2012
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