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HITCHCOCK HOMETOWN PHARMACY
CH06161D COASTAL HEALTH & WELLNESS
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Covered Entity Details
Entity Name
COASTAL HEALTH & WELLNESS
Subdivision Name
Coastal Health & Wellness - Texas City
Type
HRSA-Funded Health Center
340B ID
CH06161D
Entity Address
9850-C Emmett F. Lowry Expressway STE C103
Texas City, TX 77591
Grant Number
H80CS00344
Participating Start Date
4/1/1996
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HITCHCOCK HOMETOWN PHARMACY
Pharmacy Address
HITCHCOCK HOMETOWN PHARMACY LLC
8719 HIGHWAY 6
HITCHCOCK, TX 77563
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ami Cotharn, Chief Operating Officer
(409) 938-2218
Contract Pharmacy Representative
Hitchcock Hometown
Nandan Kumar, Pharmacist
(409) 209-0847
Signed By Date
7/15/2024
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