Contract Pharmacy Details

GEORGIA CVS PHARMACY, L.L.C.
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

GEORGIA CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 17369
200 GLYNN ISLE
BRUNSWICK, GA 31525

Pharmacy Comments

Contract Details

Approval Date

7/8/2021

Contract Begin Date

10/1/2021

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

Wellpartner
Michael Petryna, National Sales Executive
(720) 377-7745

Signed By Date

7/8/2021

340B Drug Pricing Program Database