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WINN DIXIE PHARMACY # 19
CHC26592-00 Coastal Community Health Services, Inc.
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Covered Entity Details
Entity Name
Coastal Community Health Services, Inc.
Subdivision Name
Coastal Community Health Services
Type
HRSA-Funded Health Center
340B ID
CHC26592-00
Entity Address
106 Shoppers Way, Unit 1
Brunswick, GA 31525
Grant Number
H80CS26592
Participating Start Date
10/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WINN DIXIE PHARMACY # 19
Pharmacy Address
220 RETREAT VILLAGE
SAINT SIMONS ISLAND, GA 31522
Pharmacy Comments
Contract Details
Approval Date
4/14/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Barbara Meyers, CEO
(912) 574-5074
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
4/14/2019
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