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HEB PHARMACY #643
CHC28976-00 COASTAL BEND WELLNESS FOUNDATION, INC.
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Covered Entity Details
Entity Name
COASTAL BEND WELLNESS FOUNDATION, INC.
Subdivision Name
Coastal Bend Wellness Foundation
Type
HRSA-Funded Health Center
340B ID
CHC28976-00
Entity Address
2882 Holly Road
Corpus Christi, TX 78415-4106
Grant Number
H80CS28976
Participating Start Date
4/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HEB PHARMACY #643
Pharmacy Address
4444 KOSTORYZ
CORPUS CHRISTI, TX 78415
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bill Hoelscher, CEO
(361) 814-2001 Ext: 222
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
7/16/2018
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