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PUBLIX PHARMACY #0455
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
PUBLIX PHARMACY #0455
Pharmacy Address
1601 GA HIGHWAY 40 EAST
KINGSLAND, GA 31548
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kavanaugh Chandler, CEO
(912) 275-8028 Ext: 1139
Contract Pharmacy Representative
Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388
Signed By Date
1/17/2023
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