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Walgreens MFC #21373
CH06161E COASTAL HEALTH & WELLNESS
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Covered Entity Details
Entity Name
COASTAL HEALTH & WELLNESS
Subdivision Name
Coastal Health & Wellness - Galveston
Type
HRSA-Funded Health Center
340B ID
CH06161E
Entity Address
4700 BROADWAY STREET STE 100
GALVESTON, TX 77551-4241
Grant Number
H80CS00344
Participating Start Date
7/1/1997
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
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
Walgreens
Karl Meehan, VP Health System Programs
(847) 315-2663
Signed By Date
7/15/2024
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