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GALVESTON SPECIALTY 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
GALVESTON SPECIALTY PHARMACY
Pharmacy Address
707 23RD ST
SUITE F
GALVESTON, TX 77550
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ami Cotharn, Chief Operating Officer
(409) 938-2218
Contract Pharmacy Representative
Galveston Specialty Pharmacy
Gaurav Midha, Pharmacist
(409) 877-7029
Signed By Date
7/15/2024
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