Contract Pharmacy Details

WAL-MART PHARMACY 10-0408
CH061730 GULF COAST HEALTH CENTER, INC.

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

WAL-MART PHARMACY 10-0408

Pharmacy Address

8585 MEMORIAL BLVD.
PORT ARTHUR, TX 77642

Pharmacy Comments

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Marsha E. Thigpen, Executive Director
(409) 983-1161 Ext: 880

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

4/17/2017

340B Drug Pricing Program Database