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Walgreens MFC #21373
CH06161G COASTAL HEALTH & WELLNESS
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Covered Entity Details
Entity Name
COASTAL HEALTH & WELLNESS
Subdivision Name
Coastal Health & Wellness - TCISD SBHC Calvin Vincent
Type
HRSA-Funded Health Center
340B ID
CH06161G
Entity Address
1805 13th Ave N
Texas City, TX 77590-5498
Grant Number
H80CS00344
Participating Start Date
7/1/2024
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
6/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ami Cotharn, Chief Operating Officer
(409) 938-2218
Contract Pharmacy Representative
Walgreens
Karl Meehan, VP Health System Programs
(847) 315-2663
Signed By Date
6/4/2024
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