Contract Pharmacy Details

WAL-MART CENTRAL FILL 10-2670
CHC26592-01 COASTAL COMMUNITY HEALTH SERVICES, INC.

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 CENTRAL FILL 10-2670

Pharmacy Address

608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386

Pharmacy Comments

Contract Details

Approval Date

1/10/2020

Contract Begin Date

4/1/2020

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

1/10/2020

340B Drug Pricing Program Database