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WAL-MART PHARMACY 10-0529
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
WAL-MART PHARMACY 10-0529
Pharmacy Address
6410 I-45
LA MARQUE, TX 77568
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
3/7/2022
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
7/15/2024
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