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WAL-MART PHARMACY 10-0529
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
WAL-MART PHARMACY 10-0529
Pharmacy Address
6410 I-45
LA MARQUE, TX 77568
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/7/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ami Cotharn, Chief Operating Officer
(409) 938-2218
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2024
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