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WALGREEN CO.
CH061610 Coastal Health & Wellness
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Covered Entity Details
Entity Name
Coastal Health & Wellness
Subdivision Name
Administration
Type
HRSA-Funded Health Center
340B ID
CH061610
Entity Address
9850 Emmett F Lowry Expy
Texas City, TX 77591
Grant Number
H80CS00344
Participating Start Date
4/1/1996
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15320
4101 GREENBRIAR DR STE 235
HOUSTON, TX 77098
Pharmacy Comments
Contract Details
Approval Date
7/2/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathy Barroso, CEO
(409) 938-2257
Contract Pharmacy Representative
Walgreens
Rajesh Patel, Pharmacy Manager
(713) 521-1700
Signed By Date
7/2/2019
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