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WAL-MART PHARMACY 10-0639
CHC26592-01 COASTAL COMMUNITY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COASTAL COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
Perry Park
Type
HRSA-Funded Health Center
340B ID
CHC26592-01
Entity Address
2211 Bartow Street
Brunswick, GA 31520-5604
Grant Number
H80CS26592
Participating Start Date
7/1/2017
Last Recertification Date
1/31/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0639
Pharmacy Address
150 ALTAMA CONNECTOR
BRUNSWICK, GA 31525
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Barbara Meyers, CEO
(912) 574-5074
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/12/2018
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