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WALGREEN CO.
CH061730 GULF COAST HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
GULF COAST HEALTH CENTER, INC.
Subdivision Name
GULF COAST HEALTH CENTER, INC. - PORT ARTHUR
Type
HRSA-Funded Health Center
340B ID
CH061730
Entity Address
2548 Memorial Blvd
Port Arthur, TX 77640-2825
Grant Number
H80CS00408
Participating Start Date
7/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11522
496 HIGHWAY 96 SOUTH
SILSBEE, TX 77656
Pharmacy Comments
1/20/2011 - CHANGED ADDRESS FROM 499 TO 496 TO CORRECT TYPO.
Contract Details
Approval Date
12/2/2010
Contract Begin Date
1/1/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
11/24/2010
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