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T D PHARMACY
CH042430 THE COASTAL FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
THE COASTAL FAMILY HEALTH CENTER INC
Subdivision Name
COASTAL FAMILY HEALTH CENTER CORPORATE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH042430
Entity Address
10467 Corporate Drive
Gulfport, MS 39503
Grant Number
H80CS00188
Participating Start Date
7/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
T D PHARMACY
Pharmacy Address
T-D PHARMACY, INC.
12372 HIGHWAY 49
GULFPORT, MS 39503-2741
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANGEL GREER, CEO
(228) 374-2494 Ext: 1133
Contract Pharmacy Representative
TD Pharmacy
Stephen Pisarich, Owner
(228) 832-1414
Signed By Date
10/15/2020
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