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WALGREEN CO.
CH061610 Coastal Health & Wellness
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Covered Entity Details
Entity Name
Coastal Health & Wellness
Subdivision Name
Administration
Type
HRSA-Funded Health Center
340B ID
CH061610
Entity Address
9850 Emmett F Lowry Expy
Texas City, TX 77591
Grant Number
H80CS00344
Participating Start Date
4/1/1996
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07178
100 FM 646 ROAD NORTH
DICKINSON, TX 77539-3023
Pharmacy Comments
01/24/2012 updated address line 1 (added Road West)
Contract Details
Approval Date
10/25/2011
Contract Begin Date
10/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAY W. HOLLAND
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/2/2011
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